Gonadal vein recruitment in renal cell carcinoma: Incidence, pathogenesis and clinical significance

Abstract

Objective: Gonadal vein recruitment by collateral veins in patients with renal cell carcinoma is not routinely searched for during abdominal computed tomography. We performed a retrospective view to determine the incidence of gonadal vein recruitment for collateral venous drainage in patients with renal cell carcinoma and we discuss its potential importance. Patients and methods: Abdominal CT examinations were available for 58 of 95 patients with renal cell carcinoma identified during a 3-year-period. The presence of collateral veins and recruitment of the ipsilateral gonadal vein was recorded and correlated with the estimated blood loss at surgery. Results: Eighteen of 58 tumours were small (less than 5 cm). Multiple (greater than three) collateral renal capsular veins were noted in 26 of 58 patients and few (less than three) were noted in 11. Recruitment of the gonadal vein (range 4–18 mm, mean 8 mm) was seen in 18 of 58 patients (31%) who all had multiple collaterals. Gonadal vein recruitment was only seen in patients with tumours greater than 5 cm. Mean estimated blood loss at surgery was significantly different ( P < 0.001) in 18 of 58 patients (mean, 1078 ml) with gonadal vein recruitment compared to 40 of 58 patients (mean 304 ml) without distinct visualization of the gonadal vein and compared to 22 of 40 patients with large tumours (mean 368 ml). Conclusion: Gonadal vein recruitment signifies well-developed arteriovenous shunting and high flow collateral venous drainage pathways and may be used as an index of tumour vascularity. This finding may have clinical potential in triaging patients toward pre-operative renal embolization.