P-136 - RETRO/SUPRA HEPATIC INFERIOR VENA CAVA THROMBOTIC EXTENSION IN RENAL CELL CARCINOMA SURGERY : NO NEED FOR CARDIOPULMONARY BYPASS

TOPIC:
Other
AUTHORS:
Corniquet M. (Université Paris Cité - Assistance Publique Hôpitaux de Paris.Centre, Hôpital Européen Georges Pompidou, Service de chirurgie vasculaire et endovasculaire - Inserm UMR_S 1140, laboratoire de recherches biochirurgicales, Fondation Carpentier ~ Paris ~ Fran) , Ben Abdallah I. (Université Paris Cité - Assistance Publique Hôpitaux de Paris.Centre, Hôpital Européen Georges Pompidou, Service de chirurgie vasculaire et endovasculaire - Inserm UMR_S 1140, laboratoire de recherches biochirurgicales, Fondation Carpentier ~ Paris ~ Fran) , Alsac J.M. (Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Chirurgie Vasculaire et Endovasculaire ~ Paris ~ France) , Sutter W. (Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Chirurgie Vasculaire et Endovasculaire ~ Paris ~ France) , Hurel S. (Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Chirurgie Urologique ~ Paris ~ France) , Julia P. (Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Chirurgie Vasculaire et Endovasculaire ~ Paris ~ France) , Timsit M.O. (Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Chirurgie Urologique ~ Paris ~ France) , Mejean A. (Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Chirurgie Urologique ~ Paris ~ France) , El Batti S. (Université Paris Cité - Assistance Publique Hôpitaux de Paris.Centre, Hôpital Européen Georges Pompidou, Service de chirurgie vasculaire et endovasculaire - Inserm UMR_S 1140, laboratoire de recherches biochirurgicales, Fondation Carpentier ~ Paris ~ Fran)
Introduction:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
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