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Contemporary techniques and outcomes of surgery for locally advanced renal cell carcinoma with focus on inferior vena cava thrombectomy:The value of a multidisciplinary team

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Asian Journal of Urology 2022年第3期9卷 272-281页

作者： Riccardo Campi Paolo Barzaghi Alessio Pecoraro Maria Lucia Gallo Damiano Stracci Alberto Mariotti Saverio Giancane Simone Agostini Vincenzo Li Marzi Arcangelo Sebastianelli Pietro Spatafora Mauro Gacci Graziano Vignolini Francesco Sessa Paolo Muiesan Sergio Serni Unit of Urological Robotic Surgery and Renal Transplantation University of FlorenceCareggi HospitalFlorenceItaly Department of Experimental and Clinical Medicine University of FlorenceFlorenceItaly Department of Radiology Unit of UrogenitalNephrological and Kidney Transplantation ImagingCareggi HospitalUniversity of FlorenceFlorenceItaly Hepatobiliary Unit Department of Clinical and Experimental MedicineUniversity of FlorenceAOU CareggiFlorenceItaly Liver Unit Queen Elizabeth HospitalBirminghamUK

Objective:To report the outcomes of surgery for a contemporary series of patients with locally advanced non-metastatic renal cell carcinoma(RCC)treated at a referral academic centre,focusing on technical nuances and on the value of a multidisciplinary team.Methods:We queried our prospective institutional database to identify patients undergoing surgical treatment for locally advanced(cT3-T4 N0-1 M0)renal masses suspected of RCC at our centre between January 2017 and December 2020.Results:Overall,32 patients were included in the analytic cohort.Of these,12(37.5%)tumours were staged as cT3a,8(25.0%)as cT3b,5(15.6%)as cT3c,and 7(21.9%)as cT4;6(18.8%)patients had preoperative evidence of lymph node involvement.Nine(28.1%)patients underwent nephron-sparing surgery while 23(71.9%)received radical nephrectomy.A template-based lymphadenectomy was performed in 12 cases,with evidence of disease in 3(25.0%)at definitive histopathological analysis.Four cases of RCC with level IV inferior vena cava thrombosis were successfully treated using liver transplant techniques without the need for extracorporeal circulation.While intraoperative complications were recorded in 3(9.4%)patients,no postoperative major complications(Clavien-Dindo3)were observed.At histopathological analysis,2(6.2%)patients who underwent partial nephrectomy harboured oncocytoma,while the most common malignant histotype was clear cell RCC(62.5%),with a median Leibovich score of 6(interquartile range 5e7).Conclusion:Locally advanced RCC is a complex and heterogenous disease posing several challenges to surgical teams.Our experience confirms that provided careful patient selection,surgery in experienced hands can achieve favourable perioperative,oncological,and functional outcomes.

关键词： inferior vena cava Liver transplant Open surgery Nephrectomy Renal cell carcinoma Thrombectomy

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Approaches to reconstruction of inferior vena cava by ex vivo liver resection and autotransplantation in 114 patients with hepatic alveolar echinococcosis

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World Journal of Gastroenterology 2022年第31期28卷 4351-4362页

作者： Yusufukadier Maimaitinijiati Tuerganaili AJi Tie-Min Jiang Bo Ran Ying-Mei Shao Rui-Qing Zhang Qiang Guo Mao-Lin Wang Hao Wen State Key Laboratory on Pathogenesis Prevention and Treatment of High Incidence Diseases in Central AsiaThe First Clinical CollegeXinjiang Medical UniversityUrumqi 830011Xinjiang Uygur Autonomous RegionChina Department of Hepatobiliary Surgery The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830011Xinjiang Uygur Autonomous RegionChina Xinjiang Organ Transplant Institution The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830011Xinjiang Uygur Autonomous RegionChina

BACKGROUND Hepatic alveolar echinococcosis(AE)is most commonly found in retrohepatic inferior vena cava(RHIVC).Ex vivo liver resection and autotransplantation(ELRA)can better realize the radical resection of end-stage hepatic AE with severely compromised hepatocaval confluences,and reconstruction of the affected vessels.Currently,there is a scarcity of information regarding RHIVC reconstruction in ELRA.AIM To propose reasonable RHICV reconstruction strategies for ex vivo liver resection and autotransplantation.METHODS We retrospectively summarized the clinical data of 114 patients diagnosed with hepatic AE who treated by ELRA in our department.A total of 114 patients were divided into three groups according to the different reconstruction methods of RHIVC:Group A with original RHIVC being repaired and reconstructed(n=64),group B with RHIVC being replaced(n=43),and group C with RHIVC being resected without reconstruction(n=7).The clinical data of patients,including the operation time,anhepatic phase,intraoperative blood loss,complications and postoperative hospital stay,were analyzed and the patients were routinely followed up.The normally distributed continuous variables were expressed as means±SD,whereas the abnormally distributed ones were expressed as median and analyzed by analysis of variance.Survival curve was plotted by the Kaplan-Meier method.RESULTS All patients were routinely followed up for a median duration of 52(range,12-125)mo.The 30 d mortality rate was 7.0%(8/114)and 7 patients died within 90 d.Among all subjects,the inferior vena cava(IVC)-related complication rates were 17.5%(11/63)in group A and 16.3%(7/43)in group B.IVC stenosis was found in 12 patients(10.5%),whereas thrombus was formed in 6 patients(5.3%).Twenty-two patients had grade III or higher complications,with the complication rates being 17.2%,16.3%,and 57.1%in the three groups.The average postoperative hospital stay in the three groups was 32.3±19.8,26.7±18.2,and 51.3±29.4 d(P=0.03),respectively.CONCLUSION ELRA can be considered a s

关键词： Ex vivo liver resection Alveolar echinococcosis inferior vena cava Vascular reconstruction Liver transplantation Artificial vessel

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Anesthesia and perioperative management for giant adrenal Ewing’s sarcoma with inferior vena cava and right atrium tumor thrombus:A case report

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World Journal of Clinical Cases 2022年第2期10卷 643-655页

作者： Ji-Lian Wang Chuan-Ya Xu Chun-Jing Geng Lei Liu Ming-Zhu Zhang Hua Wang Ruo-Tao Xiao Lu Liu Geng Zhang Cheng Ni Xiang-Yang Guo Department of Anesthesiology Peking University Third HospitalBeijing 100191China Department of Urology Peking University Third HospitalBeijing 100191China Department of Anesthesiology National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of Pathology School of Basic Medical SciencesPeking University Health Science CenterBeijing 100191China Intensive Care Unit Peking University Third HospitalBeijing 100191China

BACKGROUND Ewing’s sarcoma of the adrenal gland with inferior vena cava(IVC)and right atrium thrombus is extremely rare.Here,we report a case of giant adrenal Ewing’s sarcoma with IVC and right atrium tumor thrombus and summarize the anesthesia and perioperative management.CASE SUMMARY A young female was admitted to the Department of Urology with intermittent pain under the right costal arch for four months.Enhanced abdominal computed tomography revealed a large retroperitoneal mass(22 cm in diameter),which may have originated from the right adrenal gland and was closely related to the liver.Transthoracic echocardiography showed a strong echogenic filling measuring 70 mm extended from the IVC into the right atrium and ventricle.After preoperative preparation with cardiopulmonary bypass,sufficient blood products,transesophageal echocardiography and multiple monitoring,tumor and thrombus resection by IVC exploration and right atriotomy were successfully performed by a multidisciplinary team.Intraoperative hemodynamic stability was the major concern of anesthesiologists and the status of tumor thrombus and pulmonary embolism were monitored continuously.During transfer of the patient to the intensive care unit(ICU),cardiac arrest occurred without external stimulus.Cardiopulmonary resuscitation was performed immediately and cardiac function was restored after 1 min.In the ICU,extracorporeal membrane oxygenation(ECMO)and continuous renal replacement therapy(CRRT)were provided to maintain cardiac,liver and kidney function.Histopathologic examination confirmed the diagnosis of Ewing’s sarcoma.After postoperative treatments and rehabilitation,the patient was discharged from the urology ward.CONCLUSION An adrenal Ewing’s sarcoma with IVC and right atrium thrombus is extremely rare,and its anesthesia and perioperative management have not been reported.Thus,this report provides significant insights in the perioperative management of patients with adrenal Ewing’s sarcoma and IVC tumor thrombus.Intraoperative circulation fluct

关键词： Ewing’s sarcoma Anesthesia inferior vena cava Cardiac arrest Tumor thrombus

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Fracture of inferior vena cava stent after endovascular treatment for Budd-Chiari syndrome:A case series and literature review

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Journal of Interventional Medicine 2023年第2期6卷 99-102页

作者： Pengxu Ding Wen Zhou Jiayin Ding Shaofeng Shui Luo Xu Edward Wolfgang Lee Department of Intervention The First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina Department of Oncology The First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina Division of Interventional Radiology Department of RadiologyUCLA Medical CenterDavid Geffen School of Medicine at UCLALos AngelesCAUSA Division of Liver and Pancreas Transplant Surgery Department of SurgeryUCLA Medical CenterDavid Geffen School of Medicine at UCLALos AngelesCAUSA

Budd-Chiari syndrome(BCS)is a rare condition characterized by hepatic venous outflow obstruction.Balloon angioplasty,with or without stenting,is the recommended first-line treatment modality in Asian countries.As a supplement to balloon angioplasty,expandable metallic Z-stent deployment can effectively improve long-term inferior vena cava(IVC)patency.Although stent placement is a standard and frequently performed treatment,very few IVC stent-related complications,such as stent fractures,have been reported.Here we present a case series and a comprehensive review of IVC stent fractures in patients with BCS.The most common characteristic of IVC stent fractures is a protrusion of the proximal segment of the IVC stent into the right atrium and its systolic and diastolic movements along with heart rhythms.Accurate stent deployment,large-diameter balloon dilation,patient breath-holding training,preferential selection of a triple stent,and the use of an internal jugular vein approach to stent deployment may ensure precise stent localization and avoid postoperative complications.

关键词： Budd-Chiari syndrome inferior vena cava Angioplasty Stenting Fracture

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Complex inferior vena cava reconstruction during ex vivo liver resection and autotransplantation:A case report

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世界临床病例杂志 2023年第23期11卷 5602-5609页

作者： Jiayidaer Humaerhan Tie-Min Jiang Tuerganaili Aji Ying-Mei Shao Hao Wen Department of Hepatobiliary&Hydatid Diseases Digestive&Vascular Surgery CenterThe First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054Xinjiang Uygur Autonomous RegionChina State Key Laboratory of Pathogenesis Prevention and Management of High Incidence Diseases in Central AsiaThe First Clinical Medical College of Xinjiang Medical UniversityUrumqi 830054Xinjiang Uygur Autonomous RegionChina Xinjiang Clinical Research Center for Echinococcosis and Hepatobiliary Diseases First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054Xinjiang Uygur Autonomous RegionChina

BACKGROUND Ex vivo liver resection and autotransplantation(ELRA)is an essential approach for treating patients with end-stage hepatic alveolar echinococcosis(AE),and its surgical indications involve severe invasion of important hepatic vessels,which makes in vivo resection impossible.Revascularization is a major step in the process of ELRA,which is extremely challenging when the invaded vessels have huge defects.CASE SUMMARY Herein,we have reported the case of a 26-year-old patient with hepatic AE in an autologous liver graft who underwent complex inferior vena cava(IVC)reconstruction using disease-free IVC,autologous portal vein fragments,and umbilical vein within the ligamentum teres hepatis.The patient showed good surgical recovery without vascular-related complications during the long-term follow-up.CONCLUSION We reviewed three studies that have reported complex revascularization of the IVC.This case report and systematic review showed that the use of autologous perihepatic vessels prevents donor-area trauma,immune rejection,and other adverse reactions.When the blood vessel is severely invaded and a single vascular material cannot repair and reconstruct the defect,ELRA may provide a safe and feasible surgical approach,which has good prospects for clinical application.

关键词： Hepatic alveolar echinococcosis Ex vivo liver resection and autotransplantation inferior vena cava Revascularization Case report

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Variations in the bifurcation level of the abdominal aorta, formation level of the inferior vena cava, and insertion level of the left renal vein into the inferior vena cava and their clinical importance in laparoscopic surgery

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Laparoscopic, Endoscopic and Robotic Surgery 2022年第2期5卷 66-70页

作者： Mustafa Khader Tala Ghassan Al-Hyasat Ikram Yousef Salameh Amjad T.Shatarat Faculty of Medicine University of JordanAmmanJordan Department of Radiology Jordan University HospitalAmmanJordan Department of General Surgery Jordan University HospitalAmmanJordan Department of Anatomy and Histology Medical SchoolUniversity of JordanAmmanJordan

Objective: It is important to minimize the risk of major vascular injury during pneumoperitoneumestablishment in laparoscopic surgeries for patients with unusual variations in the levels of theabdominal aorta, the inferior vena cava (IVC), and the left renal vein, which will decrease the morbidityand mortality. The study aims to assess the variations regarding the bifurcation level of the abdominalaorta, formation level of the IVC, and insertion level of the left renal vein into the IVC.Methods: This retrospective study was conducted on 100 patients (50 males and 50 females) referred tothe Department of Radiology, Jordan University Hospital for abdomino-pelvic CT with intra-venouscontrast from January 2018 to December 2019. The three vessels were determined on the axial plane,the coronal plane, and the midsagittal plane. The central vertebral body height as well as the distance ofthe level of the point of interest to the upper end plate of the vertebrae were measured. Afterwards, theresults were classified into the following categories, upper end plate, lower end plate, intervertebral disc,upper half, and lower half of the vertebra.Results: The aortic bifurcation was mainly found at the level of the L4 vertebral body (65, 65%). In theremaining cases, the bifurcation was found to be variably located spanning from L3 in 11 (11%) cases to3 (3%) cases at L5. As for the iliocaval junction, the most common site was also at the level of L4 with41 (41%) cases followed by 39 (39%) cases at the level of L5, and 20 (20%) cases at the intervertebral discof L4/L5. The left renal vein most commonly joined the IVC at the level of L1 with 62 (62%) cases followedby 20 (20%) cases at the intervertebral disc T12/L1. There was wide variation in its entry to the IVCspanning from 4 (4%) cases at T12/L1 to 1 (1%) case at L4.Conclusion: The anatomical variation of the major vessels can be found in the normal population.Therefore, sufficient investigation of the anatomical position of these vessels is essential for patientsbefore laparos

关键词： Abdominal aorta inferior vena cava Left renal vein Anatomic variation Laparoscopy

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Imaging predictors for assessment of inferior vena cava wall invasion in patients with renal cell carcinoma and inferior vena cava tumor thrombus:a retrospective study

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Chinese Medical Journal 2020年第17期133卷 2078-2083页

作者： Bin-Shuai Wang You-Zhao Li Yang-Yi Fang Shu-Dong Zhang Lu-Lin Ma Department of Urology Peking University Third HospitalPeking UniversityBeijing 100191China Department of Urology Beijing Rehabilitation HospitalCapital Medical UniversityBeijing 100041China

Background:Renal cell carcinoma(RCC)has the propensity to lead to venous tumor thrombus(VTT).Nephrectomy with tumor thrombectomy is an effective treatment option but is a technically challenging surgical procedure that is accompanied by a high rate of complications.The aims of this study were to investigate pre-operative imaging parameters for the assessment of inferior vena cava(IVC)wall invasion due to a tumor thrombus in patients with RCC and to identify predictors from the intra-operative findings.Methods:Clinical and imaging data were collected from 110 patients who underwent nephrectomy with IVC tumor thrombectomy(levels Ⅰ-Ⅳ)for RCC and IVC tumor thrombus at the Peking University Third Hospital between May 2015 and March 2018.Univariable and multivariable logistic regression and receiver operating characteristic curves were used to assess the correlations between pre-operative imaging features and intra-operative macroscopic invasions of the IVC wall by tumor thrombus.Results:Among the 110 patients,41 underwent partial or segmental resection of IVC.There were univariate associations of pre-operative imaging parameters that could be used to predict the need for IVC resection,including those of the Mayo classification,maximum anterior-posterior(AP)diameter of the renal vein at the renal vein ostium(RVo),maximum AP diameter of the VTT at the RVo and IVC occlusion.For the multivariable analysis,the AP diameter of the VTT at the RVo and IVC occlusion were associated with a significantly increased risk of invasion of the IVC wall by tumor thrombus.The optimum imaging thresholds included an AP diameter of the VTT at the RVo larger than 17.0 mm and the presence of IVC occlusion,with which we predicted invasions of the IVC wall requiring IVC resection.The probabilities of intra-operative IVC resection for patients without both independent factors,with an AP diameter of the VTT at the RVo larger than 17.0 mm,with IVC occlusion,and with both concurrent factors were 5%,23%,56%,and 66%,respectively.Conclusion:An increas

关键词： Renal cell carcinoma inferior vena cava Thrombus Imaging

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Surgical treatment of hepatocellular carcinoma with inferior vena cava tumor thrombus: a new classification for surgical guidance

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Hepatobiliary & Pancreatic Diseases International 2013年第3期12卷 263-269页

作者： Ai-Jun Li Wei-Ping Zhou Chuan Lin Xi-Long Lang Zhen-Guang Wang Xiao-Yu Yang Qing-He Tang Ran Tao Meng-Chao Wu Division of Special Treatment Ⅱ Eastern Hepatobiliary Surgery Hospital Second Military Medical University Division of Hepatic Surgery Third Eastern Hepatobiliary Surgery Hospital Second Military Medical University Department of Cardiothoracic Surgery Changhai Hospital Second Military Medical University Center for Organ Transplantation and Department of General Surgery Ruijin Hospital

BACKGROUND: Hepatic resection is the main treatment modality for hepatic tumors. Advances in diagnostic technique, preoperative preparation, surgical technique, and postoperative management increased the success rate. The present study aimed to evaluate hepatectomy and resection of inferior vena cava tumor thrombus (IVCTT) in patients with hepatocellular carcinoma, and the relationship between IVCTT classification and selection of surgical technique. METHODS: We retrospectively reviewed 13 patients with hepatocellular carcinoma who had undergone hepatectomy with IVCTT resection between May 1997 and August 2009. Age, gender, diagnosis, findings of physical examination, results of preoperative laboratory investigations, radiological examination, criteria for resection, postoperative pathological results, incisions, operative technique, intraoperative transfusion, drains, and intraoperative and postoperative complications were evaluated for all patients. RESULTS: Type Ⅰ IVCTT (10 patients) was posterior to the liver and below the diaphragm; type Ⅱ IVCTT (2 patients) was above the diaphragm but still outside the atrium; and type Ⅲ IVCTT (1 patient) was above the diaphragm and in the right atrium. Type Ⅰ was treated by radical hepatectomy and removal of IVCTT with total hepatic vascular exclusion. Type Ⅱ was treated by radical hepatectomy and removal of IVCTT by incision of the diaphragm. Type Ⅲ was treated by hepatectomy and resection of the thrombus from the right atrium under cardiopulmonary bypass. There were no surgical complications and one patient has been survived for 4 years with cancer-free status. The median survival time was 18.2 months, and the 1-and 2-year survival rates were 53.8% and 15.4%, respectively. CONCLUSION: Surgical treatment is safe and feasible for treatment of IVCTT in patients with hepatocellular carcinoma, and surgical resectability can be judged according to the classification of tumor thrombus.

关键词： liver tumor inferior vena cava hepatectomy tumor thrombus total hepatic vascular exclusion

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Radical surgery for Budd-Chiari syndrome through exposure of the entire inferior vena cava of the hepatic segment

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Chinese Medical Journal 2007年第8期120卷 626-629页

作者： ZHANG Xiao-ming LI Qing-Le Department of Vascular Surgery Peking University People＇s Hospital Beijing 100044 China

Background Several kinds of radical surgery for the treatment of Budd-Chiari syndrome （BCS） have been devised. We have described preliminary efforts to treat BCS using a novel radical resection technique to expose the entire inferior vena cava （IVC） of the hepatic segment. Methods Sixty patients with BCS were treated by radical resection, including 46 men and 14 women. BCS patients ranged in age from 11 to 62 years, with 3 months to 11 years since the BCS diagnosis. The lesions included membrane occlusion of the IVC in 16 patients, double membranes within the IVC in 2 patients, double membranes within the IVC and the hepatic vein （HV） in 3 patients, IVC membrane with distal thrombosis in 10 patients, long segment thrombosis of the IVC in 5 patients （organized thrombosis in 2 patients, fresh thrombosis in 3 patients）, occlusion of the outlet of the HVs due to mural thrombosis in 2 patients, segmental occlusion of the IVC in 3 patients, membranes within the HV with IVC stenosis due to protrusion of HV stent in 1 patient, HV membranes in 11 patients, extensive occlusion of HVs in 1 patient, the whole IVC tumor thrombus with tumor thrombus of 2/3 right atrium resulting from a posterior peritoneum tumor in 1 patient, IVC leiomyosarcoma in 2 patients, IVC leiomyosarcoma with tumor thrombus into 1/2 right atrium in 1 patient, IVC thrombosis extending into right atrium in 1 patient, compression of supra-hepatic segment of IVC due to fiber trabs in 1 patient. Results All lesions were successfully resected under direct supervision. Three procedures were performed under extracorporeal circulation, 52 patients with catheterization of the right atrium, 4 patients with a cell saver, and one patient with auto-retrieval of blood. The retrieved blood was from 300 ml to 4000 ml. Transfusion of banked blood was from 400 ml to 2000 ml for 14 patients. For the other patients no transfusion of banked blood was required. One patient died of renal failure peri-operatively. Newly formed IVC membrane was found for one recurrent patien

关键词： hepatic vein thrombosis inferior vena cava

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Prevention of tumor emboli from the inferior vena cava by the Tempofilter II during resection of nephroblastoma with level III tumor thrombus

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Chinese Medical Journal 2010年第2期123卷 253-255页

作者： FENG Xiang JING Zai-ping HOU Jian-guo GAO Xu Department of Vascular Surgery Changhai Teaching Hospital Second Military Medical University Shanghai 200433. China Department of Urology Changhai Teaching Hospital Second Military Medical University Shanghai 200433. China

The optimal treatment for patients with nephroblastoma and inferior vena cava （IVC） minor thrombus is radical nephrectomy and minor thrombectomv, but the operation for patients with level III tumor thrombus is usually at high risk of puhnonary, embolism （PE）. We report one case of nephroblastoma with level III thrombus in our hospital in 2007, the vena cava tumor thrombectonly was safely performed under the protection of Tempofilter II inferior vena cava filter.

关键词： inferior vena cava nephroblastoma tumor thrombus vena cava filter

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