Surgical strategy for treating renal cell carcinoma with thrombus extending into the inferior vena cava Masatoshi Jibiki, MD, PhD, Takehisa Iwai, MD,

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Presentation transcript:

Surgical strategy for treating renal cell carcinoma with thrombus extending into the inferior vena cava Masatoshi Jibiki, MD, PhD, Takehisa Iwai, MD, PhD, Yoshinori Inoue, MD, PhD, Norihide Sugano, MD, Kazunori Kihara, MD, PhD, Nobuhiko Hyochi, MD, PhD, Makoto Sunamori, MD, PhD Journal of Vascular Surgery Volume 39, Issue 4, Pages 829-835 (April 2004) DOI: 10.1016/j.jvs.2003.12.004

Fig 1 Extension of renal tumor thrombus into the inferior vena cava. Journal of Vascular Surgery 2004 39, 829-835DOI: (10.1016/j.jvs.2003.12.004)

Fig 2 Top, Abdominal CT scan in a 58-year-old man with renal cell carcinoma (open arrow) shows a large tumor thrombus extending into the inferior vena cava (black arrow). Bottom, Cavogram in this patient showed a large tumor thrombus extending into the inferior vena cava to just below the hepatic veins (arrow). RA, Right atrium; SHV, short hepatic vein; Rt RV, right renal vein. Journal of Vascular Surgery 2004 39, 829-835DOI: (10.1016/j.jvs.2003.12.004)

Fig 3 Intraoperative photograph and diagram in the same patient as in Fig 2. The inferior vena cava (IVC) was incised after partial abdominal aortic cross-clamping was performed simultaneously with suprahepatic IVC cross-clamping and the Pringle maneuver. A, site of suprahepatic IVC cross-clamping; B, site of the Pringle maneuver; C, site of right renal vein clamping; D, site of infrarenal IVC cross-clamping; star, site of partial abdominal aortic cross-clamping, which is hidden by the surgeon's hand. Journal of Vascular Surgery 2004 39, 829-835DOI: (10.1016/j.jvs.2003.12.004)

Fig 4 Intraoperative photograph and diagram in the same patient as in Figs 2 and 3. Tumor thrombectomy was performed, and the longitudinal caval incision was closed with running sutures. GB, Gallbladder; Lt RV, left renal vein; IVC, inferior vena cava. Journal of Vascular Surgery 2004 39, 829-835DOI: (10.1016/j.jvs.2003.12.004)