Surgical Management of Renal Cell Carcinoma with Tumor Thrombus in the Renal and Inferior Vena Cava: The University of Miami Experience in Using Liver.

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Surgical Management of Renal Cell Carcinoma with Tumor Thrombus in the Renal and Inferior Vena Cava: The University of Miami Experience in Using Liver Transplantation Techniques Gaetano Ciancio, Alan S. Livingstone, Mark Soloway European Urology Volume 51, Issue 4, Pages 988-995 (April 2007) DOI: 10.1016/j.eururo.2006.11.055 Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 1 A. The whole abdominal inferior vena cava with tumor thrombus is exposed by mobilizing the liver off of retrohepatic inferior vena cava. B. Inferior vena cava dissected off the posterior abdominal wall. Mobility allows tumor milking below the major hepatic veins by the surgeon’s fingers. IVC=inferior vena cava; KT=kidney tumor; L=liver. European Urology 2007 51, 988-995DOI: (10.1016/j.eururo.2006.11.055) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 2 Abdominal removal of renal cell carcinoma with level III supradiaphragmatic, suprahepatic, infra-atrial tumor thrombus. A. The entire abdominal inferior vena cava is exposed by mobilization of the liver off the retrohepatic inferior vena cava. Diaphragm is dissected off of the suprahepatic inferior vena cava. A plane is created between the inferior vena cava and the posterior abdominal wall (⇒ ⇒ ⇒ ⇒). B. Mobility of the inferior vena cava allows milking the tumor below the hepatic veins. Clamp is placed below the hepatic veins and continual hepatic venous drainage is permitted during the closure or reconstruction of the inferior vena cava. European Urology 2007 51, 988-995DOI: (10.1016/j.eururo.2006.11.055) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 3 A. Central tendon of the diaphragm and the posterior wall of the IVC are dissected. Right atrium, IVC, porta hepatis, left renal vein, and distal IVC are clamped. B. The tumor thrombus is milked down or dissected off the atrium wall and suprahepatic IVC, then the vascular clamp is repositioned below the major hepatic veins and the porta hepatis clamp is released. European Urology 2007 51, 988-995DOI: (10.1016/j.eururo.2006.11.055) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 4 The surgical specimen includes “en-block” resection of the inferior vena cava (A), tumor thrombus (B) and kidney tumor (C). European Urology 2007 51, 988-995DOI: (10.1016/j.eururo.2006.11.055) Copyright © 2006 European Association of Urology Terms and Conditions