Diagnosis and treatment of renal cell carcinoma complicated with inferior vena cava tumor thrombus in hepatic segment and upper hepatic segment

Abstract

Surgical treatment is the only cure treatment for patients with inferior vena cava tumor thrombus in hepatic segment and upper hepatic segment. The accurate diagnosis of tumor thrombus is very important. In preoperative imaging examination, the abdominal enhanced CT scan and the inferior vena cava MRI scan were the best methods for the diagnosis and evaluation of the tumor thrombus in hepatic segment and upper hepatic segment. Compared with the tumor thrombus below the liver, the tumor thrombus in hepatic segment or above hepatic segment extend widely, and the operation are more difficult. For simple inferior vena cava tumor thrombus (the top of the thrombus has reached the level of hepatic vein), Retroperitoneal approach combined with transperitoneal approach should be used. Open surgery is the standard procedure for other tumor thrombus in hepatic segment and upper hepatic segment. In addition to exposure of inferior vena cava below the hepatic vein, the liver and the first hepatic hilum should be exposed. For tumor thrombus in the atrium, after the longitudinal incision of diaphragm, we use Milking technology to squeeze thrombus into inferior vena cava. Then we use catheterization technology to remove thrombus. For difficult atrial tumor thrombus, an extracorporeal circulation should be performed. The median incision in the chest should be performed to open the chest and open the pericardium and remove the tumor thrombus. Patients with tumor thrombus in hepatic segment or upper hepatic segment should be diagnosed as early as possible and they need actively treated by operation. Key words: Renal carcinoma; Tumor thrombus; Inferior vena cava; Hepatic segment