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. 2011 Jul;27(3):351-6.
doi: 10.4103/0970-1591.85439.

Budd-Chiari syndrome in urology: Impact on nephrectomy for advanced renal cell carcinoma

Samir P Shirodkar  1 , Mark S Soloway, Gaetano Ciancio
Affiliations

Budd-Chiari syndrome in urology: Impact on nephrectomy for advanced renal cell carcinoma

Samir P Shirodkar et al. Indian J Urol. 2011 Jul.

Abstract

Objectives: Budd-Chiari syndrome (BCS) is a poorly understood entity in urology. It results from obstruction of the hepatic veins and the subsequent complications. It has been infrequently reported to be secondary to hepatic venous obstruction from invasion by an inferior vena cava (IVC) tumor thrombus in renal cell carcinoma (RCC). We report the largest known series of patients with RCC and BCS.

Patients and methods: Ten patients presented to a tertiary hospital with locally advanced RCC with IVC tumor thrombus. All were evaluated and had clinical or radiographic evidence of BCS. All underwent nephrectomy, IVC thrombectomy or ligation, and tumor removal from the hepatic veins. The perioperative and pathological factors were measured. These included estimated blood loss (EBL) and transfusions. Inpatient factors including duration of intubation, length of intensive care unit (ICU) stay, and overall length of stay (LOS) were recorded. The tumor-free status was evaluated.

Results: The average age was 59 years. No intraoperative deaths occurred. Two intraoperative complications were noted. The mean EBL was 4244 cc; mean surgery length was 8 hours 12 minutes; and the mean ICU stay was nine days. The overall LOS averaged 13.25 days. One patient died postoperatively of sepsis and multisystem organ failure. One patient required reoperation for an abdominal wall hematoma caused by subcutaneous enoxaparin administration. Average follow-up was 28 months. Five patients are alive with no evidence of disease.

Conclusions: Budd-Chiari syndrome is a rare entity in urology, with a potential for significant morbidity and mortality. Surgical excision of the primary tumor along with thrombectomy results in alleviation of BCS and improvement in the patient.

Keywords: Budd-Chiari syndrome; hepatic vein thrombus; inferior vena cava thrombus; renal cell carcinoma.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1a
Figure 1a
Radiographic image of IVC tumor thrombus obstructing the hepatic veins (white arrow)
Figure 1b
Figure 1b
Renal cell carcinoma tumor thrombus with invasion of the hepatic vein. The mosaic pattern of the liver after gadolinium enhancement is consistent with hepatic obstruction caused by tumor thrombus (white arrow)
See this image and copyright information in PMC

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