PD35-07 EVALUATION AND MANAGEMENT OF RENAL FOSSA RECURRENCE FOLLOWING NEPHRECTOMY FOR RENAL CELL CARCINOMA

Abstract

after surgical resection a flexible cystoscope is inserted into the vena cava for direct visual inspection of the caval lumen with high flow heparinized saline irrigation. Perioperative outcomes including estimated blood loss, transfusion requirements, residual tumor, changes in management due to findings at cavoscopy, and postoperative complications were analyzed. RESULTS: All patients underwent endoscopy of the vena caval lumen without complications. 8 of 32 patients were found to have residual tumor thrombus upon visualization of the lumen. Of these, six patients were noted to have tumor invasion of the intraluminal wall resulting in cavectomy. Residual intraluminal tumor was noted in 2 patients which was bluntly resected with no residual tumor visible on repeat endoscopy. Median estimated blood loss was 3L (0.5-16) with a median intraoperative transfusion requirement of 14 units (0-63 units). Median Pringle Maneuver time was 15 minutes (3-30 minutes). Median length of stay was 10 days (4-73 days). Postoperative lower extremity edema was noted in 5 patients (3 following cavectomy) with resolution in all patients and a median resolution time of 52 days (30-322 days). There were no complications associated with vena cavoscopy. CONCLUSIONS: Vena Cavoscopy using a flexible cystoscope is an expedient and feasible technique that may be utilized intra-operatively in order to ensure clearance of residual thrombus burden within the inferior vena cava or hepatic veins and to assess for caval wall invasion.