Surgical Strategy for the Management of Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus

Abstract

Additional information is available at the end of the chapter Abstract The hallmark of renal cell carcinoma is its biological characteristic of invading the renal vein and/or inferior vena cava (IVC), which occurs in 4–10% of patients. Radical nephrectomy (RN) with tumor thrombectomy is the standard approach for treating such chal- lenging cases. Except tumor thrombus height, several factors can determine the surgical strategy, including the effect of targeted molecular therapy (TMT), invasion of the IVC wall, venous occlusion, establishment of collateral circulation, IVC thromboembolism, and primary tumor location. The surgical strategy for patients with retrohepatic vena cava tumor thrombi depends on the upper extent of the tumor thrombus. In addition, the first porta hepatis and hepatic veins are important anatomical boundaries. Based on previous studies, the effect of pre-surgical TMT is limited. The safety of IVC venography, an imaging modality that can observe congestion of the tumor thrombus and show the collateral circulation, has considerably improved. IVC interruption plays an important role in tumor thrombectomy for patients with invasion of the venous walls, complete occlusion of the vena cava, and the presence of distal thrombus. A series of retrospective and prospective studies are needed to be conducted, which will provide our clinical work with more powerful reference and basis.