Inferior vena cava (IVC) repair for tumor thrombosis is complex and associated with high morbimortality. In cases of thrombus extension to the retro/supra hepatic IVC, cardiopulmonary bypass (CPB) may be required. The aim of this study was to report outcomes of retro/suprahepatic IVC repair in renal cell carcinoma (RCC) surgery, with no CPB and to propose a new anatomical classification.
Between January 2012 and January 2021, patients who underwent surgery for RCC with retro/suprahepatic IVC tumor thrombus extension with no use of CPB were included. The extension of IVC thrombi was reported according to the major hepatic veins (MHV) ostia location: group I (below the MHV), group II (in regards with the MHV), group III (above the MHV) (Figure). Open repair included nephrectomy and IVC thrombectomy +/- IVC replacement. RCC patients with infrahepatic or supradiaphragmatic IVC thrombi, non-renal related IVC thrombosis, and patients who underwent IVC thrombectomy with CPB were not included.
During the study period, 81 IVC repair were performed in our centre. Among these, 21 patients (median age, 62 years [54-73]; 90% men) were included: group I (n=10, 48%), group II (n=5, 24%), group III (n=6, 28%). In groups I and II, infrahepatic cross clamping of the IVC was performed in all patients. Hepatic vascular exclusion was used in 4 patients of group III. IVC repair included thrombectomy in all cases, in association with primary closure (n=17, 81%), IVC ligation (n=2, 9.5%) or prosthetic graft replacement (n=2, 9.5%). Thirty-day mortality was 0%. Two patients (9.5%) had at least one major postoperative complication, including temporary hemodialysis. Two patients (9.5%) presented asymptomatic pulmonary embolism diagnosed postoperatively. There was no reintervention. Median length of hospital stay was 8 days [6-11]. After a median follow-up of 12 months [4-25], three patients (14%) died from metastasis.
IVC repair in RCC patients with IVC tumor thrombus can be performed with no use of CPB even in cases of retro/suprahepatic thrombus extension and provide acceptable postoperative outcomes.