Renal Cell Carcinoma and Stage IV Inferior Vena Cava Thrombus: Resection Without Thoracotomy

Study Overview
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Brief Summary
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Assessment of short-term outcomes of radical nephrectomy combined with IVC thrombectomy with a novel technique without thoracotomy: single center case series.

Detailed Description
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Assessment of the 30-day mortality and major complications as well as long-term oncological outcomes of three patients undergoing radical nephrectomy combined with inferior vena cava (IVC) thrombectomy with a novel technique without thoracotomy for renal cell carcinoma with IVC level IV thrombus. This is a retrospective case series carried out at Attikon University Hospital between January 2018 to March 2020.

Official Title
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Resection of Renal Cell Carcinoma and Stage IV Inferior Vena Cava Thrombus Without Thoracotomy: A Case Series and Literature Review.

Conditions
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Renal Cell Carcinoma Stage III

Intervention / Treatment
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* Procedure: Radical nephrectomy with inferior vena cava thrombectomy without thoracotomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients Documented radiological and/or pathological diagnosis of renal cell carcinoma with level IV tumor thrombus Exclusion Criteria: American Anesthesia Association (ASA) Class V and/or any contraindications to general anesthesia

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Transabdominal inferior vena cava thrombectomy<br>Patients undergoing radical nephrectomy and inferior vena cava thrombectomy transabdominal without thoracotomy | Procedure: Radical nephrectomy with inferior vena cava thrombectomy without thoracotomy<br>* The abdomen was accessed through a Makuuchi incision. After mobilization of the liver and assessment of the inferior vena cava infiltration (IVC), IVC was clamped below the level of the renal veins. In order to get access to the intrapericardial IVC, an incision was made through the tendon of the diaphragm and a clamp was placed first in the hepatoduodenal ligament (Pringle maneuver) and then in the endopericardial portion of the IVC, in that order. A longitudinal 3-4 cm incision was made incorporating the junction of IVC and right renal vein. After tumor removal thrombus was removed and a fine clamp was placed at the IVC just below the hepatocaval junction and immediate release of the clamping of the hepatoduodenal ligament. Total endopericardial clamp time was 4 minutes. Patients then underwent radical nephrectomy in a standard fashion with en bloc resection of the IVC thrombus.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Short term mortality rate | Percentage of patients' postoperative deaths | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Short term major complications' rate | Incidence of Clavien/Dindo grade 3 or more postoperative complications | 30 days | 
| Recurrence rate | Rate of local or systemic recurrence | 27 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Renal cell carcinoma, Tumor thrombus, Inferior vena cava, level IV