Fukushima Satsuki, Uemura Motohide, Gotoh Kunihito, Ujike Takeshi, Wada Hiroshi, Miyagawa Shigeru, Toda Koichi, Sawa Yoshiki
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
J Surg Oncol. 2017 Nov;116(6):775-782. doi: 10.1002/jso.24709. Epub 2017 Jun 12.
For tumor thrombus in the inferior vena cava (IVC) complicated with kidney cancer, we built a surgical team to achieve (1) en bloc tumor resection; (2) xeno-pericardial patch IVC repair; and (3) minimum organ damages. We reviewed outcome of the case series to verify rationale of this approach.
A consecutive series of 12 patients having the IVC tumor thrombus by renal cell carcinoma in the last 3 years was enrolled. Minimum kidney ischemia was induced in five cases (Procedure I), whereas liver and kidney ischemia was induced in five cases (Procedure II). Mild hypothermic extracorporeal circulation was used in two cases (Procedure III).
There was no mortality or severe morbidities related to the surgery. Postoperative recovery was most prompt by the Procedure I. Liver and kidney ischemic time was longer in the Procedure III than the Procedure II, whereas organ function was not substantially impaired in either series. The resected IVC margin was free from the cancer in all cases, while local recurrence was not seen in any cases.
En bloc resection with xeno-pericardial patch repair of the IVC was successfully performed in the tumor thrombus complicated with kidney cancer with minimum organ damage.
对于合并肾癌的下腔静脉（IVC）肿瘤血栓，我们组建了一个手术团队，以实现：（1）整块肿瘤切除；（2）用异种心包补片修复下腔静脉；（3）使器官损伤最小化。我们回顾了该病例系列的结果，以验证这种方法的合理性。
纳入过去3年中连续12例患有肾细胞癌合并下腔静脉肿瘤血栓的患者。5例采用使肾脏缺血时间最短的方法（方法I），5例采用使肝脏和肾脏缺血的方法（方法II）。2例采用轻度低温体外循环（方法III）。
无手术相关死亡或严重并发症。方法I术后恢复最快。方法III中肝脏和肾脏的缺血时间比方法II长，但两组的器官功能均未受到实质性损害。所有病例切除的下腔静脉边缘均无癌细胞，且无局部复发。
对于合并肾癌的肿瘤血栓，采用整块切除并使用异种心包补片修复下腔静脉的方法成功实施，且器官损伤最小。
