Abstract：In 4%-10% of cases of advanced RCC, the venous system is involved, of which 22% to 70% involve the inferior vena cava.Median survival was only 5 months in untreated patients with renal cancer and thrombolism of the inferior vena cava.The 30-day mortality from radical nephrectomy combined with inferior vena cava thrombectomy was 1.5%-10%, and the 5-year specific survival rate was 40%-60%.Surgery should follow the principle that each type of venous carcinoma thrombosis corresponds to a class of surgical strategy, and different techniques are required on different sides.Preoperative CT or MRI is required to adequately evaluate inferior vena cava carcinoma thrombosis, and perioperative patient management is critical to surgical success.Grades I and II carcinoma thrombosis favors laparoscopy or robotic surgery. Grades III and IV carcinoma thrombosis suggests targeted drug therapy before surgery, followed by surgery after reduction or downgrade of the carcinoma thrombosis.
[1] Siegel RL, Miller KD, Fuchs HE, et al.Cancer Statistics, 2021[J]. CA Cancer J Clin, 2021,71(1):7-33. [2] Ciancio G, Manoharan M, Katkoori D, et al.Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: single-center experience[J]. EurUrol, 2010,57(4):667-672. [3] Neves RJ, Zincke H.Surgical treatment of renal cancer with vena cava extension[J]. Br J Urol, 1987,59(5):390-395. [4] 黄庆波, 彭程, 顾良友, 等. 肾肿瘤伴静脉瘤栓“301分级系统”及手术策略(附100例病例分析)[J]. 微创泌尿外科杂志, 2017,6(6):328-332. [5] Cost NG, Delacroix SEJ, Sleeper JP, et al.The impact of targeted molecular therapies on the level of renal cell carcinoma vena caval tumor thrombus[J]. Eur Urol, 2011,59(6):912-918. [6] Qi N, Wu PJ, Chen JC, et al.Cytoreductive nephrectomy with thrombectomy before targeted therapy improves survival for metastatic renal cell carcinoma with venous tumor thrombus: a single-center experience[J]. World J Surg Oncol, 2017, 15(1):4. [7] 彭程, 顾良友, 黄庆波, 等. 术前靶向治疗对肾癌合并下腔静脉癌栓的疗效分析[J]. 中华泌尿外科杂志, 2018(Z1):45-46. [8] Psutka SP, Leibovich BC.Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma[J]. Ther Adv Urol, 2015,7(4):216-229. [9] Ghoreifi A, Djaladat H.Surgical tips for inferior vena cava thrombectomy[J]. Curr Urol Rep, 2020,21(12):51. [10] Subramanian VS, Stephenson AJ, Goldfarb DA, et al.Utility of preoperative renal artery embolization for management of renal tumors with inferior vena caval thrombi[J]. Urology, 2009,74(1):154-159. [11] Zargar H, Addison B, McCall J, et al. Renal artery embolization prior to nephrectomy for locally advanced renal cell carcinoma[J]. ANZ J Surg, 2014,84(7-8):564-567. [12] Blute ML, Boorjian SA, Leibovich BC, et al.Results of inferior vena caval interruption by greenfield filter, ligation or resection during radical nephrectomy and tumor thrombectomy[J]. J Urol, 2007,178(2):440-445, 444. [13] Woodruff DY, Van Veldhuizen P, Muehlebach G, et al.The perioperative management of an inferior vena caval tumor thrombus in patients with renal cell carcinoma[J]. Urol Oncol, 2013,31(5):517-521. [14] Haidar GM, Hicks TD, El-Sayed HF, et al. Treatment options and outcomes for caval thrombectomy and resection for renal cell carcinoma[J]. J Vasc Surg Venous Lymphat Disord, 2017,5(3):430-436. [15] 马鑫, 宣云东, 黄庆波, 等. 肾癌合并下腔静脉癌栓的机器人手术策略[J]. 临床外科杂志, 2021,29(2):104-107. [16] Gu LY, Ma X, Gao Y, et al.Robotic versus Open level I-II inferior vena cava thrombectomy: amatched group comparative analysis[J]. J Urol,2017,198(6):1241-1246. [17] Chopra S, Simone G, Metcalfe C, et al.Robot-assisted Level II-III inferior vena cava tumor thrombectomy: step-by-step technique and 1-year outcomes[J]. Eur Urol, 2017,72(2):267-274. [18] Wang BJ, Li HZ, Huang QB, et al.Robot-assisted retrohepaticinferior vena cava thrombectomy: first or second porta hepatis as an important boundary landmark[J]. Eur Urol, 2018,74(4):512-520. [19] Loh-Doyle J, Bhanvadia S, Patil M B, et al.Vena cavoscopy in the assessment of intraluminal vena cavaltumor involvement[J]. Urology, 2018,113:105-109. [20] Ciancio G, Gonzalez J, Shirodkar SP, et al.Liver transplantation techniques for the surgical management of renal cell carcinoma with tumor thrombus in the inferior vena cava: step-by-step description[J]. Eur Urol, 2011,59(3):401-406. [21] Pouliot F, Shuch B, Larochelle JC, et al.Contemporary management of renal tumors with venous tumor thrombus[J]. J Urol, 2010,184(3):833-841, 1235. [22] Wang BJ, Huang QB, Liu K, et al.Robot-assisted level III-IV inferior vena cava thrombectomy: initial series with step-by-step procedures and 1-yr outcomes[J]. Eur Urol, 2020,78(1):77-86. [23] Shen DL, Du SL, Huang QB, et al.A modified sequential vascular control strategy in robot-assisted level III-IV inferior vena cava thrombectomy: initial series mimicking the open 'milking' technique principle[J]. BJU Int, 2020,126(4):447-456. [24] Zhao GD, Zhang XP, Hu MG, et al.Step-by-step and orderly lowering of the height of inferior vena cava tumor thrombus is the key to robot-assisted thrombectomy for Mayo III/IV tumor thrombus[J]. BMC Cancer, 2022,22(1):151. [25] Djaladat H, Ghoreifi A, Basin MF, et al.Perioperative outcome of suprarenal resection of vena cava without reconstruction in urologic malignancies: acase series and review of the literature[J]. Urology, 2020,142:146-154. [26] 叶剑飞,马潞,林赵磊,等.腔静脉节段切除术在处理侵犯腔静脉的肾肿瘤瘤栓中的应用[J].北京大学学报(医学版), 2018,50(1):183-187. [27] Du S, Huang Q, Yu H, et al.Initial series of robotic segmental inferior vena cava resection in left renal cell carcinoma with cavaltumor thrombus[J]. Urology, 2020,142:125-132. [28] Abel EJ, Thompson RH, Margulis V, et al.Perioperative outcomes following surgical resection of renal cell carcinoma with inferior vena cava thrombus extending above the hepatic veins: a contemporary multicenter experience[J]. Eur Urol, 2014,66(3):584-592.
