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Surgical Approach to Tumor Thrombus of Renal Cell Carcinoma at the Level between Hepatic Vein and Diaphragm
Author(s) -
Isaka Shigeo,
Okano Tatsuya,
Shimazaki Jun,
Masuda Masahisa,
Miyazaki Masaru
Publication year - 1997
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/j.1442-2042.1997.tb00131.x
Subject(s) - medicine , diaphragm (acoustics) , renal cell carcinoma , thrombus , surgery , porta hepatis , inferior vena cava , pulmonary vein , renal vein , carcinoma , vein , radiology , cardiology , kidney , atrial fibrillation , physics , acoustics , loudspeaker
Background The curative resection of tumor thrombus of renal cell carcinoma often provides a good prognosis, but the best surgical method for resection at the level between hepatic vein and diaphragm is still a matter of controversy. Methods We performed transabdominal surgery without cardio‐pulmonary bypass on 4 patients with tumor thrombus at the level between hepatic vein and diaphragm. The surgical procedures were as follows: The right lobe of the liver was separated and detached from the retroperitoneum, and then the vena cava was clamped just below the diaphragm simultaneous with clamping the porta hepatis. After complete circulatory isolation of the vena cava, the tumor thrombus was resected. Results: There were no severe complications postoperatively. Two patients died of cancer 18 and 38 months after surgery, and the other 2 are alive without evidence of disease after 62 and 66 months. Conclusion: This anatomically rational approach is thought to be a good alternative to the pull‐through method or cardio‐pulmonary bypass for removing a tumor thrombus at this level.