Inferior venacavography for renal cell carcinoma combined with inferior vena cava thrombus
Shen Dan1, Chang Xiao1, Du Songliang1, Liu Fengyong2, Li Hongzhao1, Wang Baojun1, Shi Taoping1, Zhu Jie1, Huang Qingbo1, Wang Zhongxin1, Jia Zhuomin1, Zhang Peng1, Lyu Xiangjun1, Fan Yang1, Gao Yu1, Peng Cheng1, Li Shichao1, Liu Kan1, Cheng Qiang1, Pei Hongfei1, Zhang Xu1, Ma Xin1
1Department of Urology, Chinese PLA General Hospital, Beijing 100853, China;
2Department of Interventional Radiology, Chinese PLA General Hospitall
Abstract：Objective:Inferior venacavography has special advantages in the preoperative assessment for renal cell carcinoma (RCC) combined with inferior vena cava (IVC) tumor thrombus, but it hasn't been widely used for its doubtful safety and efficacy. The purpose of this study is to evaluate the utility of inferior venacavography in RCC with IVC tumor thrombus and to definite its indications. Methods:We reviewed clinical data of 9 patients diagnosed as RCC combined with IVC thrombus undergoing preoperative inferior venacavography from January 2017 to June 2017. Radiographic data were retrospectively analyzed to identify the obstruction location of IVC, extension of tumor thrombus, and the establishment of distal collateral circulation. Results:Nine patients were included in the analysis, including 5 females (55.6%) and 4 males (44.4%). To conduct inferior venacavography, all patients accepted right femoral vein puncture under local anaesthesia and then the catheter was inserted over the guidewire to inject contrast medium. None of them showed any complication after venacavography until surgery was conducted. As for surgery, 7 cases underwent robotic assisted laparoscopic radical nephrectomy and IVC thrombectomy, and 2 cases were given open radical nephrectomy and IVC transection. Four cases were classified as Mayo Ⅲ, 4 cases as Mayo Ⅱ and 1 as Mayo Ⅰ. The mean length of the IVC thrombus was 7.9 cm (SD: 2.4). Mean operation time was 335.6 min (SD: 94.1). Mean blood loss was 2 200mL (SD: 2 089mL). Mean postoperative hospital stay was 18.8 days (SD: 5.9). Postoperative complications included thrombosis in the common iliac vein and internal iliac vein (1 case), and retroperitoneal hematoma and anemia (1 case). During the follow-up period of 2-5 months, venacavography showed patent IVC or adequate collateral circulation establishment in all patients, and no lower extremity edema or abdominal varicose veins was observed. Conclusions:Inferior venacavography is a safe and effective preoperative assessment for RCC combined with tumor thrombus in IVC. Further large sample studies are needed to evaluate the application of venacavography.
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