Graft Reconstruction of Inferior Vena Cava for Renal Cell Carcinoma Stage pT3b or Greater

Abstract

To review the methods and outcomes for simultaneous radical nephrectomy and inferior vena cava (IVC) graft reconstruction at our institution. Renal cell carcinoma has the potential to propagate and invade the IVC, requiring resection and/or reconstruction of the IVC concurrently with radical nephrectomy. A prospective database of patients undergoing simultaneous radical nephrectomy with IVC reconstruction for renal cell carcinoma was queried. The data were collected and analyzed for patients who had undergone IVC graft reconstruction. A total of 17 patients were identified from 1999 to 2010, with a median age of 61 years (range 36-77). The tumor was right sided in 14 patients. The median tumor size was 12 cm (range 7.5-23), 15 tumors had clear cell histologic findings, and 16 were high grade. Seven patients had clinical metastasis found on imaging preoperatively, with another 4 having lymph node metastasis on pathologic examination. Of the 17 patients, 11 underwent patch grafting (3 expanded polytetrafluoroethylene and 8 bovine pericardium) and 6 underwent IVC interposition (3 Dacron and 3 expanded polytetrafluoroethylene). Also, 5 and 3 patients underwent cardiopulmonary and venovenous bypass, respectively. The mean estimated blood loss was 4 L, and the mean hospitalization was 7 days (range 5-16). Six patients experienced perioperative complications, with 1 perioperative mortality. Two patients overall developed graft thrombosis. Of the 6 patients initially without metastasis, the recurrence-free and overall survival rate was 50% and 83%, respectively, at a mean of 55 months. Of the 11 patients initially with metastasis, the recurrence-free and overall survival rate was 18% and 45%, respectively, at a mean of 13 months. For selected patients with advanced renal cell carcinoma and extensive IVC thrombus, resection with patch or interposition grafting of the IVC yields acceptable patency rates, minimal complications related to the graft, and reasonable oncologic results in a high-risk patient population.