Removal Of Tumor Thrombus Research Articles

Renal Cell Carcinoma With Tumor Thrombus: A Case Series in Puerto Rico.

Renal cell carcinoma (RCC) is one of the most common types of kidney cancer. While RCC tends to present as a localized tumor, a notable proportion may present with distant metastasis. In some instances, RCC may also present with intravascular tumor extension, often called tumor thrombus (TT). Its presence confers a worse prognosis and has important implications for the tumor's staging and treatment. Despite extensive documentation of RCC TT in the US, limited data exists regarding its presentation, management, and outcomes in Puerto Rico(PR). This study aims to broaden the available information on RCC TT, emphasizing surgical management and outcomes. We also provide descriptive data on patient demographics and clinical presentation to improve decision-making among clinicians caring for Puerto Rican men and women. In this single-center, retrospective study, we evaluated patients who underwent partial or total nephrectomy at Saint Luke's Episcopal Medical Center between 2018 and 2022. Data was abstracted from electronic health records (EHR). Patients without documented evidence of TT during the peri-operative period were excluded from the study. A total of 220 patient records were evaluated, of which 12met the inclusion criteria for the study. Caseswere categorized using the latestRCCTT guidelines. Central tendency measurements were used to describe the sample distribution. The mean was considered to make assumptions regarding the prevalent observations, and the median was considered to rule out possible outliers.Categorical data were evaluated using proportion analyses, including TT extension level and BMI variables. Fisher's exact test evaluated the association between the World Health Organization/International Society of Urological Pathology(WHO/ISUP) grade and TT extension level. Most patients lacked TT-related symptoms. Themost severe presenting symptom was a pulmonary embolism (8.3%). Hypertension (83.3%), BMIgreater than 25 at the time of diagnosis (75%), and type 2 diabetes mellitus (66.7%) were the most common comorbid conditions within our cohort. Nearly 75% ofpatients underwent laparoscopic radical nephrectomy with TT resection. One left-sided level III case was managed by laparoscopic-assisted open radical nephrectomy with a right subcostal incision. There were zero intraoperative complications and two postoperative complications. The histopathological reports of all cases were consistent with clear cell carcinoma, and half of the cases (n=6) were WHO/ISUP G4. All patients are alive and free of disease. RCCis a common renal neoplasm in PRthatcanpresent withintravascular tumor extension.Our findings do not establish a definitive association between BMI, tumor size, WHO/ISUP grading, and TT extension level. Our study shows that laparoscopic removal of RCC TT is a safe and effective approach. However, the generalizability of our findings is limited by the study's design and sample size. Future research should focus on identifying predictive markers, establishing effective screening protocols, and determining if our hybrid approach has comparable outcomes to the standard open approach.

Role of Intra-operative Transesophageal Echocardiographic Examination in Inferior Vena Cava Tumor Thrombus Removal in a Case of Renal Ewing’s Sarcoma

Ewing’s sarcoma belongs to primitive neuroectodermal tumors. Renal Ewing’s sarcoma is an extremely rare tumor that can progress to the inferior vena cava (IVC) or right atrium (RA). Renal tumors with IVC/RA extension entail removal of the tumor, including tumor thrombus in IVC with or without the use of cardiopulmonary bypass, depending on the tumor thrombus extent. Intra-operative transesophageal echocardiography provides the latest staging of tumor thrombus, its characteristics, and mobility, guides IVC clamping for tumor removal, aids in troubleshooting hemodynamic instability, and monitors completeness of tumor removal post-procedure. Transesophageal echocardiographic examination forms an indispensable part of intra-operative management in any case of IVC tumor thrombus removal.

32 - The level of blood loss during the removal of tumor thrombus of the inferior vena cava in patients with renal cell carcinoma

32 - The level of blood loss during the removal of tumor thrombus of the inferior vena cava in patients with renal cell carcinoma

Impact of positive vascular margins status after surgical resection of non-metastatic renal cell carcinoma with caval tumour thrombus: a propensity score multicentre study.

Data evaluating the impact of positive vascular margins (PVMs) following surgical resection of non-metastatic renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus are lacking. To analyze the oncological impact of positive vascular margins following surgical resection of RCC with IVC tumor thrombus. Patients who underwent radical nephrectomy with the removal of IVC tumour thrombus for RCC between 2000 and 2019 were included. PVMs were identified from pathology reports defined as microscopically identified tumour present in the IVC wall at the site of resection or in case of thrombus was not completely removed. To achieve balance in baseline characteristics between patients with PVMs versus negative vascular margins, we used inverse probability of treatment weighting (IPTW) based on the propensity score. Local recurrence, distant metastasis and overall mortality were evaluated between groups using Cox proportional hazards regression models. 209 patients were analyzed. Among them, 49 (23%) patients with PVMs were identified. Median follow-up was 55months. After adjustment, excellent balance was achieved for most propensity score variables. In IPTW analysis, PVMs was associated with a higher risk of local recurrence (HR = 3.66; p < 0.001) without any impact on systemic recurrence (HR = 1.15; p = 0.47) or overall mortality (HR = 1.23; p = 0.48). Limitations include the sample size and unmeasured confounding. Our results suggest that a PVMs in patients with RCC after nephrectomy with thrombectomy is associated with a higher risk of local recurrence, however, it did not appear to influence the risk of distant metastasis or death.

Multidisciplinary surgical approach to renal cancer with vena cava invasion and pulmonary embolism

Renal cancer is unique for many reasons. One reason is that renal cell carcinoma can grow directly into the drainage veins of the kidney, which enter the inferior vena cava leading to the heart. This growth of tumor cells into the veins is called atumor thrombus and is alocally aggressive renal cancer. The present article informs about the experience of our cardiac surgery department together with the transplant surgery department in successful surgical removal of akidney with tumor, with invasion into the inferior vena cava, right atrium of the heart and pulmonary artery in two case reports. A32 years old female without significant history, with suddenly evolving dyspnea was urgently admitted to hospital. Her condition was suspected to be caused by pulmonary artery embolisation. The diagnosis was confirmed by CT scan which revealed unknown tumor mass of the right kidney and tumor embolisation in inferior vena cava and pulmonary artery. The patient was urgently operated by avascular surgeon and cardiothoracic surgeon. They successfully performed left radical nephrectomy and total thromboembolectomy of the tumorous masses from vena cava inferior and pulmonary artery. The postoperative course was without complications, postoperative CT revealed no residual masses, and the patient was discharged in agood condition from the hospital. A58 years old male with arterial hypertension suffered from orchiepididymitis. CT scan showed atumor of the left kidney with propagation of tumorous masses to inferior vena cava and pulmonary artery. In elective surgery the vascular surgeon and cardiothoracic surgeon successfully performed left radical nephrectomy with total thromboembolectomy of the tumorous masses from inferior vena cava and pulmonary artery. After surgery atemporary paralytic ileus and an episode of atrial fibrillation occurred. Both are common postoperative complications related to the given surgical procedure. Follow-up CT scan showed no residual tumor or thrombus in inferior vena cava and pulmonary artery. Echocardiography revealed persistent dilation of right compartments of the heart with good systolic functions of both ventricles. The patient was discharged from hospital in agood condition. Surgical removal of renal tumor and tumor thrombus - radical nephrectomy with tumor thrombectomy - can be acurative treatment and can ensure long-term survival of the patient. Depending on the extent of the tumor thrombus, these operations can be performed in different ways - mini-invasive, robotic or open. When open surgery is used, it is possible to perform the procedure with or without extracorporeal circulation (cardiopulmonary bypass - CPB) depending on the extent of the disease.

Resection of Inferior Vena Cava Without Reconstruction for Intravascular Intrusion of Wilms Tumor

Persistent inferior vena cava (IVC) tumor thrombus in Wilms tumor patients represents a management challenge. We describe three pediatric cases with preoperative evaluation documenting complete IVC occlusion and well-developed collaterals. They underwent nephrectomy and tumor thrombus removal accomplished with circumferential resection of the retrohepatic IVC without vascular reconstruction. All patients are asymptomatic and disease-free at 9, 2.5, and 2 years after stopping therapy. Cavectomy without reconstruction is safe and well tolerated in Wilms tumor patients with completely occlusive IVC tumor thrombus. Additionally, when performed en bloc with nephrectomy and with clear margins, cavectomy obviates the need for radiotherapy per protocol.

P073 - The results of tumor thrombus removal from the right atrium without extracorporeal circulation

P073 - The results of tumor thrombus removal from the right atrium without extracorporeal circulation

Removal of the Tumor Thrombus from the Right Atrium without Extracorporeal Circulation: Emphasis on the Displacement of the Tumor Apex.

Objectives To assess the outcomes of cavoatrial tumor thrombus removal using the liver transplantation technique for thrombectomy, a retrospective study was conducted. Materials and Methods Five patients with atrial tumor thrombi who underwent piggy-back mobilization of the liver, surgical access to the right atrium from the abdominal cavity, and external manual repositioning of the thrombus apex below the diaphragm (milking maneuver) were included into the study. Extracorporeal circulation was used in none of the cases. The average length of the atrial component of the tumor was 20.0 ± 11.7 mm (10 to 35 mm), and the width was 14.8 ± 8.5 mm (10 to 30 mm). In this work, the features of patients and surgical interventions as well as perioperative complications and mortality were analyzed. Results External manual repositioning of the tumor thrombus apex below the diaphragm was successfully performed in all patients. Tumor thrombi with the length of the atrial part up to 1.5 cm were removed through the extrapericardial approach. For evacuation of the thrombi with the large atrial part (3.0 cm or more), a transpericardial surgical approach was required. Specific complications associated with the access to the right atrium from the abdominal cavity (paresis of the right phrenic nerve, pneumothorax, and mediastinitis) were not detected in any case. The average clamping time of the supradiaphragmatic inferior vena cava (IVC) was 6.3 ± 4.6 min. The volume of intraoperative blood loss varied from 2500 to 5600 ml (an average of 3675 ± 1398.5 ml). Conclusion Our work represents the initial experience in the liver transplantation technique for thrombectomy in distinct and well-selected patients with atrial tumor thrombi. The effectiveness of this approach needs further study. The video presentation of our research took place in March 2019 at the 34th Annual EAU Congress in Barcelona.

SUN-182 Rare Case of Adrenocortical Carcinoma with Tumor Extension into the Inferior Venacava, Right Atrium and Right Ventricle

Introduction: Adrenocortical carcinoma is a rare and highly aggressive malignancy with an incidence rate of 1-2 per million population per year. It is an aggressive tumor with early metastasis to lungs, liver, bone and lymph nodes. Venous tumor thrombosis to inferior venacava (IVC), atrium or ventricle is rare and is considered as a tumor extension instead of metastatic disease, but with a poor prognostic outcome. Clinical Case: We present a rare case of adrenocortical carcinoma with tumor extension into the IVC, right atrium and right ventricle. A 62-year-old female with history of breast cancer on anastrozole presented to the clinic for a routine screening colonoscopy. Patient was noted to have uncontrolled hypertension before the procedure, so was sent to the ER. Upon further interviewing she complained of increasing abdominal distension, hirsutism, and bilateral lower extremity swelling over the past six months. CT abdomen revealed a large 10 x11 x13 cm heterogeneously enhancing mass arising above the right kidney, with extensive tumor extension into the IVC, right atrium and right ventricle. MRI too characterized a large mass in the right adrenal gland with tumor thrombus extension into the IVC, right atrium, and right ventricle. Hormonal studies demonstrated elevated cortisol, dehydroepiandrosterone-sulfate and testosterone levels. A 1 mg dexamethasone suppression test inadequately suppressed cortisol levels, consistent with Cushing’s syndrome due to endogenous over secretion of cortisol. Free plasma and urine metanephrine levels were normal. Plasma renin and aldosterone concentration were within normal limits. With the cooperation of a multidisciplinary team, patient underwent right adrenalectomy with removal of tumor thrombus from right atrium and right ventricle under cardiopulmonary bypass. Surgical pathology confirmed adrenocortical carcinoma. She was started on mitotane as adjuvant therapy. Patient was also noted to have a lung nodule with biopsy showing oncocytic neoplasm favoring metastasis from adrenal cortex. She did receive chemotherapy for the lung metastasis with decrease in the size of the nodule. Conclusion: Adrenal cortical carcinoma is a rare disease and the venous tumor thrombus to IVC, atrium and ventricle is even rarer and has a poor prognostic outcome. Complete tumor resection is the only curative approach with adjuvant therapies aiming to decrease the risk of recurrence only. Due to the aggressive nature of the tumor and quick development of metastasis, early diagnosis gives the best chance of resection and hence the greatest chances of survival.

Removal of tumor thrombus from the azygos vein in an esophageal squamous cell carcinoma patient

BackgroundEsophageal squamous cell carcinoma with tumor thrombus in the arch of the azygos vein has not been reported to date. Neoadjuvant chemotherapy can decrease the stage in patients with advanced preoperative tumor staging, regaining surgical opportunities and significantly prolonging progression-free survival and overall survival. Herein, we present a case of esophageal squamous cell carcinoma accompanied by tumor thrombus in the arch of the azygos vein, and the patient underwent radical surgery after neoadjuvant chemotherapy.Case presentationA 63-year-old male with esophageal squamous cell carcinoma was found to have tumor thrombus formation in the arch of the azygos vein. Four courses of neoadjuvant chemotherapy with the TP regimen (paclitaxel plus nedaplatin) were given. Reexamination revealed a significant reduction in tumor and tumor thrombus volume. Therefore, McKeown radical resection for esophageal cancer and removal of the tumor thrombus in the arch of the azygos vein were performed. Postoperative pathology suggested complete remission of the esophageal tumor and the presence of small focal cancer tissues in the arch of the azygos vein.ConclusionWe report a case of esophageal squamous cell carcinoma with tumor thrombus formation in the azygos vein. We conducted radical resection after 4 rounds of neoadjuvant chemotherapy, and the pathological results revealed complete remission of the tumor. We report our experience addressing this rare case, and we hope to find the underlying mechanism of tumor thrombus formation and whether it has any effects on prognosis in our future study.

P1342 Secondary cardiac tumour -a metastasis from renal cell carcinoma via transvenous extension

Abstract Secondary cardiac tumour is 20-40 times more common than primary cardiac tumour. Most common tumour that metastasize to the heart are lung cancer, breast cancer and hematologic malignancy. Melanoma and pleural mesothelioma has high inclination to metastasize. Other cancer with high rate of cardiac metastasis include gastric, ovarian, renal and pancreatic cancer. The presentation of cardiac metastasis is usually non-specific and sometimes mimic other cardiac condition. We would like to present one such case where we used multimodality approach for proper evaluation. A 57 year old lady presented with intermittent chest discomfort for one month which worsen on day of admission. Otherwise she had good effort tolerance. Electrocardiogram had no acute ischemic changes and Troponin T was not elevated. Bedside echocardiography revealed a large cardiac mass in right atrium around 66mm x 29mm, protruding to right ventricle. Apart from that noted aneurysm of interatrial septum towards LA. MRI cardiac showed an inhomogenous mass extending from the right renal vein and inferior vena cava(IVC) into the right atrium(RA). The tumour mass in the right atrium a highly mobile and flops across the tricuspid valve into the right ventricle during ventricular diastole causing right ventricular outflow tract obstruction. The mass was hyperintense on T2- and isointense on T1-weighted images. There was vascularity within the mass with inhomogenous gadolinium enhancement. There was also 2 masses in right kidney , a larger inhomogenous encapsulated mass at the right lower pole and smaller at lower pole. The findings were suggestive of a primary renal cell carcinoma with tumour mass extension into right renal vein, inferior vena cava and into the right atrium. A staging CT scan thorax , abdomen and pelvis did not show any other possible primary source of cancer and reconfirm the extracardiac finding of the MRI. No evidence of tumour extension into hepatic veins and left renal vein. There was however small nodular opacities in both right and left lung suggesting lung metastasis. A combined operation was done with our cardiothoracic surgeon and urologist from nearby tertiery hospital. Nephrectomy and removal of tumour thrombus from IVC and RA was done with 18 degree Celcius circulatory arrest with cardiopulmonary bypass. Section of renal mass showed a poorly circumscribed lobulated tumour with areas of hemorrhage and necrosis. The tumour was close to capsule but has not breached it. The tumour was mainly clear cell carcinoma variant, nuclear grade III. Section from IVC that extend to RA appeared elongated sausage-like measuring 150mm in length and 30mm in diameter had tumour embolus. Pulmonary artery and perirenal blood vessel also had tumour emboli. The hilar nodes however were free from tumour. Patient recovered well and was discharged home day 9 post operation. Follow-up echocardiogram 3weeks post-op showed no recurrence of the mass and good LV function. Abstract P1342 Figure. Echo, CTscan, MRI and Pathology images

Pure laparoscopic radical nephrectomy and inferior vena caval tumor thrombus removal in patients with complicated renal tumor.

Pure laparoscopic radical nephrectomy and inferior vena caval tumor thrombus removal in patients with complicated renal tumor.

Surgical effect analysis of hepatocellular carcinoma with different lymphovascular invasion

Objective To compare the clinical features and surgical outcomes of hepatocellular carcinoma (HCC) combined with portal venous tumor thrombus (PVTT) and hepatic venous tumor thrombus (HVTT) or bile duct tumor thrombi (BDTT), and analyze the effects of different tumor thrombus (TT) types and different surgical methods for TT on prognosis. Methods The retrospective cross-sectional study was conducted. The clinical data of 220 HCC patients with lymphovascular invasion (LVI) who were admitted to the Affiliated Cancer Hospital of Guangxi Medical University between January 2004 and December 2014 were collected. Of 220 patients, 140 were combined with PVTT, 36 with HVTT and 44 with BDTT. According to patients′ conditions, they underwent tumor and TT resection, and tumor resection + TT removal or single TT removal. Observation indicators: (1) comparisons of clinical features of HCC patients with PVTT or HVTT or BDTT; (2) surgical and postoperative situations; (3) follow-up and survival. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to December 2015. Measurement data with normal distribution were represented as ±s. Comparisons among 3 indicators were analyzed using the one-way ANOVA, and comparisons between 2 indicators were analyzed using the t test. Comparisons of count data were analyzed using the chi-square test. The survival curve and rate were respectively drawn and calculated by the Kaplan-Meier method, and the Log-rank test was used for survival analysis. Results (1) Comparisons of clinical features of HCC patients with PVTT or HVTT or BDTT: number of patients with Child-pugh A, Child-pugh B and peritoneal effusion, tumor diameter and cases with tumor capsule were respectively detected in 133, 7, 23, (10±4)cm, 91 in HCC patients with PVTT and 35, 1, 4, (9±4)cm, 27 in HCC patients with HVTT and 35, 9, 16, (6±4)cm, 15 in HCC patients with BDTT, with statistically significant differences (χ2=12.693, 10.408, F=11.300, χ2=17.188, P 0.05). ④ Of 44 HCC patients with BDTT, 24, 6 and 14 were respectively detected in type Ⅰ, Ⅱ and Ⅲ BDTTs, and median survival time, 1-, 3- and 5-year survival rates were respectively 38 months, 87.5%, 60.4%, 34.9% in type Ⅰ BDTT patients and 26 months, 83.3%, 16.7%, 0 in type Ⅱ BDTT patients and 35 months, 78.6%, 50.0%, 21.4% in type Ⅲ BDTT patients, showing no statistically significant difference in survival (χ2=5.312, P>0.05). Of 44 patients, median survival time, 1-, 3- and 5-year survival rates were respectively 38 months, 91.3%, 59.5%, 34.3% in 23 patients undergoing tumor and TT resection and 26 months, 85.7%, 35.7%, 15.3% in 21 patients undergoing tumor resection + TT removal through incising common bile duct, showing no statistically significant difference in survival (χ2=2.071, P>0.05). Conclusions HCC patients with PVTT have larger tumor diameter and worse liver dysfunction, and are prone to peritoneal effusion. HCC patients with different LVI undergo surgery. There is better prognosis in HCC patients with BDTT, and good prognosis in patients with HVTT, while poorer prognosis in patients with PVTT. The postoperative survival of HCC patients with PVTT is associated with TT type, and patients will have better prognosis after tumor resection + TT removal if TT type is confirmed earlier. The postoperative survival of HCC patients with BDTT is not associated with TT type, tumor resection + TT removal maybe prolong postoperative survival time. Key words: Carcinoma, hepatocellular; Portal venous tumor thrombus; Hepatic venous tumor thrombus; Bile duct tumor thrombus; Surgical procedures, operative; Prognosis; Overall survival rate

Vena Cavoscopy in the Assessment of Intraluminal Vena Caval Tumor Involvement

To improve confirmation of complete tumor thrombus removal in advanced malignancy, we report on our experience using intraoperative vena cavoscopy using a flexible cystoscope to confirm complete thrombus resection. Patients with renal cell carcinoma or testicular cancer associated with inferior vena caval tumor involvement benefit from surgical resection of the primary tumor and the tumor thrombus. Intraoperative assessment of the vena cava represents a technical challenge, particularly when the thrombus is friable and involves the hepatic veins, or there is caudal extension of thrombus toward the bifurcation. From 2006 to 2014, 36 patients underwent tumor thrombectomy and vena cavoscopy. When residual caval thrombus was suspected, a flexible cystoscope was inserted into the vena cava for direct visual inspection of the caval lumen. Perioperative outcomes including residual tumor, changes in management, and postoperative complications were analyzed. All patients underwent endoscopy of the caval lumen without complications. Eight of 36 (22%) patients were found to have residual tumor thrombus visualized during cavoscopy. Five of these patients had evidence of residual mass and caval invasion within the caval lumen that ultimately resulted in cavectomy. Two patients had residual tumor thrombus that was bluntly removed. One patient was found to have significant involvement of the hepatic veins. Vena cavoscopy using a flexible cystoscope is a practical technique that may be utilized intraoperatively to ensure clearance of residual thrombus burden within the inferior vena cava and to assess for caval invasion.

Role of transoesophageal echocardiography in renal cell carcinoma: a brief review

Transoesophageal echocardiography (TOE) is regularly used in cardiac and also increasingly in non-cardiac surgeries. It has a leading role in the perioperative management of renal cell carcinoma with tumour extension...

Phrenicoabdominal venotomy for tumor thrombectomy in dogs with adrenal neoplasia and suspected vena caval invasion.

To describe a technique for tumor thrombectomy by phrenicoabdominal venotomy in dogs with adrenal neoplasia and suspected caval invasion and to report complications and outcomes associated with the procedure. Retrospective case series. Eight client-owned dogs with invasive adrenal tumors. Medical records of dogs diagnosed with adrenal tumors with extension of thrombus into the phrenicoabdominal vein (PAV) and vena cava were reviewed. Cases where phrenicoabdominal venotomy without cavotomy for thrombus resection was performed were included. Data collected from the medical records included signalment, clinical signs, physical examination findings, diagnostic imaging results, preoperative laboratory testing, surgical technique, surgical and postoperative complications and outcome. Phrenicoabdominal venotomy was successful in removal of vena caval thrombosis in 7 of 8 dogs. In one case, an attempt was made to remove a large vena caval thrombus through a distended PAV resulting in fragmentation of the thrombus and the need to extend the incision into the vena cava. In all dogs, complete removal of tumor thrombus was achieved. Two dogs died in the perioperative period, one from cardiopulmonary arrest and a second from bronchopneumonia and pancreatitis. The remaining 6 dogs were discharged from the hospital. Thrombectomy through a phrenicoabdominal venotomy may obviate the need for a cavotomy in a subset of dogs with invasive adrenal neoplasia.

V13 - New surgical technique of renal artery control during nephrectomy with tumor thrombus removal

V13 - New surgical technique of renal artery control during nephrectomy with tumor thrombus removal

27 - The transabdominal extrapericardial access to the supradiaphragmatic inferior vena cava (IVC) during tumor thrombus removal

27 - The transabdominal extrapericardial access to the supradiaphragmatic inferior vena cava (IVC) during tumor thrombus removal

Outcomes of hepatic resection for hepatocellular carcinoma with major portal or hepatic vein tumor thrombosis: retrospective cohort study

Background: Major vascular invasion by hepatocellular carcinoma (HCC) is a poor prognostic factor. The outcome of hepatic resection for this advanced stage tumor remains unclear. Objectives: To clarify the outcome of hepatic resection for HCC with vascular invasion. Methods: Between January 2005 and May 2013, 13 of 272 patients who underwent hepatic resection of HCC had a confirmed major portal or hepatic vein tumor thrombosis. The perioperative and long-term outcomes of this cohort of patients were retrospectively reviewed. Results: Ten of the 13 patients underwent preoperative transarterial chemoembolization (TACE). None showed tumor progression or liver function deterioration. All underwent hepatic resection with complete removal of tumor thrombus. The vascular resection margin was microscopically negative in all patients. Postoperative complications occurred in 62%. Most complications were pleural effusion, which necessitates percutaneous drainage. No perioperative mortality occurred. The median follow up time was 38.5 months (range 10–112). The median overall survival was 38.5 months. The 1-, 3-, and 5-year recurrence free survival was 93%, 36%, and 36%, respectively. The 1-, 3-, and 5 year-overall survival was 93%, 76%, and 48%, respectively. Nine patients had intrahepatic tumor recurrence, extrahepatic recurrence, or both. Five with recurrence underwent TACE, radiofrequency ablation, or surgical resection. On univariate analysis, the only factor that tended to relate to worse overall survival was underlying liver cirrhosis (P = 0.056). Conclusions: Hepatic resection for HCC with invasive thrombosis, combined with careful patient selection, close postoperative follow up, and early treatment of recurrence offers a chance of long-term survival. Keywords: Hepatocellular carcinoma, preoperative TACE, surgical resection, survival outcomes, tumor thrombus

525 Control of the renal artery after removal of tumor thrombus from the inferior vena cava: Analysis of the efficacy and safety of a new surgical approach

525 Control of the renal artery after removal of tumor thrombus from the inferior vena cava: Analysis of the efficacy and safety of a new surgical approach