[Renal adenocarcinoma with retrohepatic vena cava thrombus: role of extracorporeal circulation in a retrospective series of 10 cases]

Abstract

Introduction: Renal cell carcinoma is accompanied by tumour thrombus in the inferior vena cava (IVC) in 4 to 10% of cases. Since the use of cardiopulmonary bypass (CPB), surgery for extensive thrombus has been improved by reduction of blood loss, facilitating complete resection of the kidney and thrombus and possible repair of the inferior vena cava.

Objectives: To analyse a retrospective series of 10 cases and to compare the complications of CPB and conventional surgery by direct clamping.

Material and methods: From February 1985 to December 1997, 413 patients were operated for renal cancer, including 23 (5.6%) patients with tumour thrombus in the inferior vena cava. Ten of these 23 cases of inferior vena caval thrombus were retrohepatic. Group I (5 patients) was operated under CPB and profound hypothermia at 16 degrees C (mean duration of bypass: 30 min). Group II (5 patients) was operated by conventional surgery (CS) (mean clamp time: 12 min).

Results: No difference in terms of intraoperative complications was observed between the two groups, but 2 deaths occurred in group II due to respiratory decompensation, 1 and 2 weeks postoperatively.

Conclusion: The level of the thrombus in the inferior vena cava determines the mode of vascular management. The presence of invasion of the inferior vena cava wall is difficult to predict because of the poor sensitivity of radiological examinations. CPB did not induce any excess morbidity in this series. The use of CPB in renal cancers with retrohepatic thrombus facilitates the resection procedure and allows inferior vena cava reconstruction in a bloodless environment.