scholarly journals Open Surgery for Localized RCC

2007 ◽  
Vol 7 ◽  
pp. 742-752 ◽  
Author(s):  
Kathy Vander Eeckt ◽  
Steven Joniau ◽  
Hein Van Poppel
Keyword(s):  
Open Surgery ◽  
Inferior Vena ◽  
Vena Cava ◽  
Standard Of Care ◽  
Stage Migration ◽  
Low Grade ◽  
Extended Lymph Node Dissection ◽  
Nephron Sparing ◽  
Open Radical Nephrectomy ◽  
Localized Renal Cell Carcinoma

The only possibility for cure in localized renal cell carcinoma (RCC) is surgery. Open radical nephrectomy (RN), as described by Robson, has long been the gold standard. Nevertheless, as a consequence of the increased use of abdominal imaging modalities, a continuing stage migration towards small, low-grade RCC lesions has become evident during the last decades. Together with this stage migration, nephron-sparing surgery (NSS), less-invasive therapies (laparoscopic RN and NSS), and minimally invasive therapies (radiofrequency ablation [RFA], cryoablation) have been developed and are gaining popularity. The value of laparoscopic RN and open NSS are acknowledged worldwide, but the value of laparoscopic NSS, RFA, and cryoablation remains to be established. Despite this evolution, there is still a place for open surgery for localized RCC. Open NSS is, at present, considered the standard of care for localized RCC less than 4 cm, while open RN still has a place for larger lesions, certainly when an extended lymph node dissection or adrenalectomy is warranted, or when a tumor thrombus is extending into the inferior vena cava. This review provides the data that support open surgery in clear, selected cases of RCC.

scholarly journals Nephron Sparing Surgery for Renal Angiomyolipoma with Inferior Vena Cava Thrombus in Tuberous Sclerosis

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Adrien Riviere ◽  
Thomas Bessede ◽  
Jean-Jacques Patard
Keyword(s):  
Inferior Vena Cava ◽  
Tuberous Sclerosis ◽  
Inferior Vena ◽  
Vena Cava ◽  
Nephron Sparing Surgery ◽  
Renal Angiomyolipoma ◽  
Nephron Sparing ◽  
Mean Size ◽  
The Mean

Introduction. Angiomyolipoma is a common benign renal tumor. It is associated with Tuberous Sclerosis Complex (TSC) in 20% of patients. Angiomyolipomas are classically multiple, bilateral, and growing; they may lead to complications such as Wunderlich syndrome or, in rare cases, to venous extension.Observation. a 74-year-old woman with TSC presented with an angiomyolipoma of the right kidney with inferior vena cava (IVC) fatty thrombus. She underwent partial nephrectomy and thrombectomy. After a 7-year follow-up there was no evidence of recurrence or metastasis and her renal function was preserved.Review of Literature. It is the 44th reported angiomyolipoma associated with IVC thrombus. The mean size of angiomyolipomas was 86.1 mm and 67.4% of patients were symptomatic. Pulmonary embolism was found in 6 patients. There were 2 cases of recurrence/metastatic outcome after radical nephrectomy and thrombectomy. They were associated with epithelioid form. The mean size of epithelioid tumors was significantly bigger than in classical angiomyolipomas (127.1 mm versus 82.6 mm,P=0.037). With a median follow-up of 12 months, 91.3% of patients were recurrence and metastasis free, with 3 cases of nephron sparing surgery.Conclusion. Nephron sparing surgery for angiomyolipoma with IVC fatty thrombus can be safely performed in TSC, even in sporadic angiomyolipoma.

scholarly journals Resection of a Catecholamine-Elaborating Retroperitoneal Paraganglioma Invading the Inferior Vena Cava

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
E. M. Mannina ◽  
Z. Xiong ◽  
R. Self ◽  
E. Kandil
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Standard Of Care ◽  
Mass Effect ◽  
Preoperative Imaging ◽  
Critical Component ◽  
Adjacent Structures

Paragangliomas are rare tumors originating outside of the adrenal medulla which can be associated with catecholamine secretion or mass effect, one of which typically leads to their discovery. The differences between these tumors and traditional intra-adrenal pheochromocytomas are a subject of recent investigations. Standard of care therapy is medical management and surgical resection of the tumor. When tumors are biochemically active, medical optimization of the autonomic nervous system is a critical component to a safe, definitive resection. Tumors arising in the retroperitoneum present technical challenges for the surgeon as they are often large and difficult to access, making an oncologic resection much more difficult. Lastly, these tumors are mostly benign and rarely invade adjacent structures—an operative finding not always predicted by preoperative imaging—which, if present, adds significant complexity and risk to the resection. A case illustrating these challenges in the management of a biochemically active retroperitoneal paraganglioma invading the inferior vena cava follows.

scholarly journals Low-Grade Endometrial Stromal Sarcoma with Inferior Vena Cava Extension: First Report in Korea

2014 ◽  
Vol 30 (3) ◽  
pp. 98-101 ◽  
Author(s):  
Mi-Hyeong Kim ◽  
Chan-Kwon Jung ◽  
Jeong-Kye Hwang ◽  
In-Sung Moon ◽  
Ji-Il Kim
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Endometrial Stromal Sarcoma ◽  
Low Grade ◽  
First Report ◽  
Stromal Sarcoma

scholarly journals Low-Grade Endometrial Stromal Sarcoma with Intravenous and Intracardiac Extension: A Case Report

2020 ◽  
Author(s):  
Xiaoshan Chai ◽  
Hui Ding ◽  
Peng Zhou ◽  
Xilong Mei ◽  
XiaoXue Li ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Pelvic Mass ◽  
Endometrial Stromal Sarcoma ◽  
Iliac Vein ◽  
Low Grade ◽  
Ki 67 ◽  
Stromal Sarcoma

Abstract Background: Low-grade endometrial stromal sarcoma (ESS) is rare mesenchymal neoplasm, which has an indolent history with late recurrences. ESS usually spread through the lymph nodes and venous system but very seldom involve large vessels or the heart.Case presentation: A 38-year-old Chinese woman was admitted to our department due to pelvic mass found on physical examination. The superior and inferior vena cava CT angiography (CTA) showed an enlarged uterine as well as low density image in the left internal iliac vein, the left common iliac vein, the inferior vena cava, the left renal vein adjacent to the heart and the right atrium, with a range of 110*16mm. The filling defect of right atrium was about 30*14mm. The three-dimensional computed tomography reconstruction showed that the mass originated from the uterine and invaded into the reproductive vein, subsequently extended along the inferior vena cava to the right atrium. Needle biopsy of the pelvic mass was performed and the tissue indicates smooth muscle. The preoperative diagnosis was intravascular leiomyomatosis and the patient underwent radical resection: thrombectomy and total hysterectomy with bilateral salpingo-oophorectomy. Postoperative histopathology revealed low grade endometrial stromal sarcoma. Microscopically, the tumors in both original uterine lesions and intravascular and intracardiac metastases shared morphologic features characterized by neoplastic cells similar to proliferative-phase endometrial stromal cells, in which small spiral artery differentiation was recognized and tumor tissue showed invasive growth pattern by inserting into the surrounding smooth muscle. Immunohistochemistry showed tumor cells were reactive to Estrogen Receptor, Progesterone Receptor,CD10. Primary uterine foci showed cyclin D1(5%+) and Ki-67(20%+),whereas metastatic lesions of the intracardiac and the intravascular component identified cyclin D1(negative) and Ki-67(2%+). The patient is alive without evidence of recurrence 3 months after surgery.Conclusions: Distant metastasis of low-grade endometrial stromal sarcoma is rare, especially involving large vessels or the heart. This case demonstrates that malignant tumor metastasis should be considered as a differential diagnosis of intracardiac and intravascular masses. The treatment rely on multidisciplinary cooperation.

Single Institution Experience with Inferior Vena Cava Filters.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 914-914
Author(s):  
Nikhil Bhalla ◽  
Anca Bulgaru ◽  
Lynn Church ◽  
Dinesh Kapur ◽  
Herb Lustberg ◽  
...  
Keyword(s):  
High Risk ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Low Grade ◽  
Ivc Filter ◽  
Ivc Filters ◽  
Additional Surgery ◽  
Clot Burden ◽  
Retrievable Ivc Filters

Abstract Inferior vena cava (IVC) filters are used in patients (pts.) with Deep Venous Thrombosis (DVT) to prevent pulmonary embolism (PE) when anticoagulation cannot be administered. The purpose of this study was to analyze the use and outcomes of IVC filters in a community hospital. We reviewed the medical records of all pts. who had IVC filters implanted at William W. Backus Hospital between May 2003 and May 2005. Follow up information was obtained up to August 2005 by mailings from the attending physicians. 125 IVC filters were implanted in 121 pts., ages 18 to 93, with 61 males and 60 females. The indications for implantation were contraindication as follows: to anticoagulation in 72 pts. (58%), up coming surgical procedures in 33 pts. (26%), and severity of clot burden in 20 pts. (16%). 123 (98%) filters were deployed into an infrarenal position and 2 into a suprarenal position due to extensive clot in the IVC. Of the 105 filters that were not retrieved 60 were Gunther Tulip (GT) retrievable IVC filters, 42 were Cordis Trapease (CT) permanent IVC filters, 2 were stainless steel Greenfield IVC filters, and 1 was a Cordis Optease (CO) IVC filter. Of the 20 retrieved filters 19 were GT retrievable IVC filters and 1 was a CO IVC filter. Of the 125 filters, 74 were intended to be permanent filters (59%) and 51 (41%) were inserted with intention of retrieval. 31/51 (60%) were eventually not retrieved because of various reasons: need for additional surgery (12), poor pulmonary reserve (5), high-risk of bleeding (5), severity of clot burden (4), short life expectancy (4), and extremely high risk of recurrent DVT (1). Short-term and long-term anticoagulation was used in conjunction with the IVC filters in 21 and 81 pts. respectively. 38 (31%) of the 121 pts. experienced recurrent venous thromboembolism (VTE), 37 developed symptomatic DVT and 1 had a symptomatic PE. 3/20 (15%) of the pts. who had their filters retrieved developed recurrent DVT (18, 22, and 76 days after filter retrieval) compared with 34/105 (32%) pts. who had permanent filters. The only objectively documented symptomatic PE occurred in a pt. with a permanent filter. This pt. had a recurrent PE 7 months post GT IVC filter insertion diagnosed by chest CT scan with PE protocol. Complications were as follows: 1 pt. had transient hypertension immediately after IVC insertion and 1 pt. developed a transient low-grade fever after retrieval. 1 pt. developed retroperitoneal hematoma upon retrieval 75 days after implantation as documented by an IVC Gram and this pt. recovered without need for any intervention and there were no adverse clinical consequences. The implantation periods ranged from 2 to 104 days in the 20 retrieved filters with mean/median of 20/9 days. 4 of the 20 retrieved filters (20%) contained trapped emboli and none of these pts. subsequently developed PE. The GT retrievable IVC filter is now the filter of choice at our institution and can be implanted permanently or with retrieval in mind. Conclusion: Retrievable filters were removed up to 104 days post insertion in this series of pts. and the incidence of complications was negligible. Retrievable IVC filters may be substituted for permanent IVC filters to preserve the option of retrieval, and retrieval of filters beyond 3 months post implantation is feasible and should be studied further.

Tumor Thrombectomy Without Bypass for Low-Grade Malignant Tumors Extending into the Inferior Vena Cava: Report of Two Cases

Surgery Today ◽  
2006 ◽  
Vol 36 (5) ◽  
pp. 465-469 ◽  
Author(s):  
Masatoshi Jibiki ◽  
Yoshinori Inoue ◽  
Norihide Sugano ◽  
Takehisa Iwai ◽  
Tomoyasu Katou
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Malignant Tumors ◽  
Vena Cava ◽  
Low Grade

scholarly journals 125I Brachytherapy Seeds Implantation for Inoperable Low-Grade Leiomyosarcoma of Inferior Vena Cava

2013 ◽  
Vol 14 (2) ◽  
pp. 278 ◽  
Author(s):  
Yuliang Li ◽  
Yongzheng Wang ◽  
Bin Liu ◽  
Zheng Li ◽  
Wujie Wang
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Low Grade ◽  
125I Brachytherapy

scholarly journals Management of inferior vena cava injury and secondary thrombosis after percutaneous nephrolithotomy: a case report

2021 ◽  
Vol 49 (11) ◽  
pp. 030006052110588
Author(s):  
Pan Li ◽  
Dengjiu Mao ◽  
Jie Zhou ◽  
Hongmei Sun
Keyword(s):  
Inferior Vena Cava ◽  
Percutaneous Nephrolithotomy ◽  
Open Surgery ◽  
Inferior Vena ◽  
Vena Cava ◽  
Urinary Calculi ◽  
Major Complication ◽  
Peripheral Vascular ◽  
Treatment Regimens ◽  
Repeated Infection

Percutaneous nephrolithotomy (PCNL) remains an important method for treating upper urinary calculi. However, bleeding and peripheral vascular injury are serious complications of PCNL. Injury of the inferior vena cava accompanied by secondary thrombosis has rarely been reported clinically. We treated a patient who experienced bleeding during PCNL to establish a channel. A catheter was used to make a renal fistula, and the inferior vena cava was implanted. The wound was fixed and compressed by balloon injection, and secondary thrombosis and repeated infection occurred after the operation. A filter was then placed, the water balloon was released, and the fistula was removed. The anti-bacterial and anticoagulant filter was removed. This major complication was successfully managed. In our patient, during PCNL, the renal fistula entered the inferior vena cava by mistake. If this issue cannot be treated in time, it can easily lead to the formation of secondary thrombosis. A fistula can be extracted through an inferior vena cava filter, and anticoagulant treatment and other conservative treatment regimens can be used to treat patients in this situation. These treatments avoid the possibility of further damage from open surgery.

Erector spinae plane and intra thecal opioid (ESPITO) analgesia in radical nephrectomy utilising a rooftop incision: novel alternative to thoracic epidural analgesia and systemic morphine: a case series

2020 ◽  
Vol 20 (4) ◽  
pp. 847-851
Author(s):  
Ashani Ratnayake ◽  
Lihxuan Goh ◽  
Lee Woolsey ◽  
Roshan Thawale ◽  
Benjamin L. Jackson ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Radical Nephrectomy ◽  
Inferior Vena ◽  
Enhanced Recovery ◽  
Vena Cava ◽  
Thoracic Epidural Analgesia ◽  
Erector Spinae ◽  
Opioid Analgesia ◽  
Thoracic Epidural ◽  
Open Radical Nephrectomy

AbstractBackgroundOpen radical nephrectomy and inferior vena cava exploration through a roof top incision involves significant peri-operative morbidity including severe postoperative pain. Although thoracic epidural analgesia provides excellent pain relief, recent trends suggest search for effective alternatives. Systemic morphine is often used as an alternative analgesic technique. However, it does not provide dynamic analgesia and can often impede recovery in patients undergoing major surgery on the abdomen. The authors present the first report of a novel analgesic regimen in this cohort with good outcomes.MethodsFive patients undergoing open radical nephrectomy and inferior vena cava exploration received erector spinae plane infusion and intra thecal opioid analgesia at a tertiary care university teaching hospital. Outcomes included dynamic analgesia, length of hospital stay and complicationsResultsFive adult patients undergoing major upper abdominal surgery, who refused thoracic epidural analgesia, received erector spinae plane infusion and intrathecal opioid analgesia. Patients reported effective dynamic analgesia, minimal use of rescue analgesia, early ambulation and enhanced recovery.ConclusionThe novel regimen that avoids both epidural analgesia and systemic morphine can be an option in enabling enhanced recovery in this cohort.

Sign in / Sign up

Export Citation Format

Share Document