Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, U.S.A.;
Department of Urology, University of Miami Miller School of Medicine, Miami, FL, U.S.A.
Anticancer Res. 2021 Jan;41(1):335-340. doi: 10.21873/anticanres.14780.
BACKGROUND/AIM: Large or bilateral multiple renal cell carcinoma (RCC) without/with tumor thrombus (TT) in the renal vein (RV) or inferior vena cava (IVC) poses a challenge to the surgeon due to the potential for massive hemorrhage, tumor thromboemboli and dialysis, and the situation is more critical due to Covid-19 pandemic. We report our experience and measures in dealing with challenging cases of large or multiple RCCs without/with TT during the ongoing Covid-19 pandemic.
Between 4/2020-10/2020, five patients underwent RCC resection with/without TT. Patients 1 and 2 had RCCs/TT in RV; Patient 3 had RCC/TT supradiaphragmatic below right atrium; Patient-4 had a 26 cm RCC; Patient-5 had multiple RCCS as part of Birt-Hogg-Dube syndrome.
Patients were preoperatively tested negative for Covid-19. Operation times were 105, 85, 255, 200 and 247 minutes for Patients 1-5. Estimated blood loss was: 100, 50, 3,900,100 and 50 ml, respectively. Patient 3 underwent RCC resection en bloc with IVC/TT. Patients 1 and 2 underwent resections of RCC/TT in RV. Patient 4 underwent a 26 cm RCC resection. Patient 5 underwent laparoscopic bilateral radical nephrectomies. No immediate postoperative complications were reported.
We successfully managed 5 challenging cases of RCCs despite the recommendations imposed by hospitals due to Covid-19 pandemic, with favorable outcomes.
背景/目的：由于存在大出血、肿瘤血栓栓子和透析的风险，以及新冠疫情的影响，对于肾静脉（RV）或下腔静脉（IVC）内无/有肿瘤栓子的大体积或双侧多发性肾细胞癌（RCC）的外科医生来说是一个挑战。我们报告了在新冠疫情期间处理大体积或多发性 RCC 伴/不伴肿瘤栓子的挑战性病例的经验和措施。
在 2020 年 4 月至 2020 年 10 月期间，有 5 名患者接受了 RCC 切除术伴/不伴肿瘤栓子。患者 1 和 2 为 RV 内的 RCC/肿瘤栓子；患者 3 为右心房下腔静脉以上的 RCC/肿瘤栓子；患者 4 为 26cm 的 RCC；患者 5 为 Birt-Hogg-Dube 综合征的多发性 RCCS。
患者术前新冠病毒检测均为阴性。患者 1-5 的手术时间分别为 105、85、255、200 和 247 分钟。估计出血量分别为 100、50、3900、100 和 50ml。患者 3 行 RCC 整块切除术伴 IVC/肿瘤栓子切除术。患者 1 和 2 行 RV 内 RCC/肿瘤栓子切除术。患者 4 行 26cm RCC 切除术。患者 5 行腹腔镜双侧根治性肾切除术。无术后立即发生的并发症。
尽管新冠疫情期间医院实施了相关建议，我们仍成功处理了 5 例具有挑战性的 RCC 病例，获得了良好的结果。
