Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Ann Surg Oncol. 2024 Jul;31(7):4787-4794. doi: 10.1245/s10434-024-15324-7. Epub 2024 May 10.
Renal function after left renal vein (LRV) ligation following en bloc resection of segmental inferior vena cava (IVC) and right kidney is understudied. We assessed the impact of LRV ligation on postoperative renal function following en bloc resection of segmental IVC and right kidney.
We retrospectively reviewed 28 patients who underwent LRV ligation during en bloc resection of segmental IVC and right kidney. Patient demographics, tumor characteristics, intraoperative factors, complications, length of hospital and intensive care unit (ICU) stay, and patient survival were collected. Pre- and postoperative renal function was retrospectively analyzed.
Twenty patients underwent robot-assisted surgery and eight patients underwent open surgery. The median operative time was 162 min and estimated blood loss was 350 mL. Ten patients had normal renal function and 12 patients had an initial increase in creatinine but improved gradually. Six patients developed acute renal failure; five patients gradually recovered in 5-32 days after temporary hemodialysis. Renal replacement therapy significantly correlated with maximal anterior-posterior diameter of the LRV (p = 0.001). Complications were observed in 11 cases, four of which were Clavien-Dindo grades I-II. Thirteen patients were alive with no recurrence, nine patients were alive with metastasis, and six cases died during the follow-up period.
LRV ligation following en bloc resection of segmental IVC and right kidney is feasible, with no significant long-term impact on renal function. The maximum anterior-posterior diameter of the LRV is a reliable method for predicting renal replacement therapy in the absence of collateral circulation.
整块切除节段性下腔静脉（IVC）和右肾后左肾静脉（LRV）结扎对术后肾功能的影响尚未得到充分研究。我们评估了整块切除节段性 IVC 和右肾后 LRV 结扎对术后肾功能的影响。
我们回顾性分析了 28 例在整块切除节段性 IVC 和右肾过程中进行 LRV 结扎的患者。收集了患者人口统计学、肿瘤特征、术中因素、并发症、住院和重症监护病房（ICU）住院时间以及患者生存情况。回顾性分析了术前和术后肾功能。
20 例患者接受机器人辅助手术，8 例患者接受开放手术。中位手术时间为 162 分钟，估计出血量为 350 毫升。10 例患者肾功能正常，12 例患者肌酐初始升高但逐渐改善。6 例发生急性肾衰竭；5 例在临时血液透析后 5-32 天逐渐恢复。肾脏替代治疗与 LRV 的最大前后径显著相关（p=0.001）。11 例出现并发症，其中 4 例为 Clavien-Dindo 分级 I-II。13 例患者存活且无复发，9 例患者存活且转移，6 例患者在随访期间死亡。
整块切除节段性 IVC 和右肾后 LRV 结扎是可行的，对肾功能无明显长期影响。LRV 的最大前后径是预测无侧支循环时肾脏替代治疗的可靠方法。
