Tumor Thrombus Into the Inferior Vena Cava After Resection of Renal Cell Carcinoma: Recurrence or Tumor Thrombus Left Behind?

Abstract

To describe a series of 3 cases of renal cell carcinoma that developed a metachronic recurrence in the form of inferior vena cava tumor thrombus after a first attempt of curative intent by means of radical nephrectomy. A complete work-up consisting of total body computed tomography and transesophagic echocardiography was performed in all cases. After extensive counseling a decision for surgical excision was made. We used a transplant-based approach to eliminate every vestige of visible neoplastic tissue including the tumor thrombus in all cases. Three different approaches, including tangential and circumferencial excision of the inferior vena cava with or without caval replacement by prosthetic vascular graft were used for caval management after thrombectomy. Estimated blood loss ranged between 500 and 2000 cc. Transfusion requirements varied from 1-9 red blood cell packed units. Complete thrombectomy along with excision of all visible neoplastic lesions was achieved in all cases. One of the patients experimented a cardiac arrest on postoperative day 7 without fatal consequences that increased de length of stay (range 7-30 days). No other major complications were registered. None of the patients died in the first 30 days after the procedure. The transplant-based surgical approach to thrombectomy in these cases provides for excellent exposure and vascular control, thus minimizing the complication rate and resulting a safe treatment option for the patient.