Details

Autor(en) / Beteiligte

• Lim, Chetana
• Salloum, Chady
• Lahat, Eylon
• Ossesis, Michael
• Gomez Gavara, Concepcion
• Compagnon, Philippe
• Azoulay, Daniel

Titel

Resection of Renal Cell Carcinoma Involving the Liver with Tumor Thrombus Extending into Inferior Vena Cava Requiring Venovenous Bypass

Ist Teil von

• Case-Based Lessons in the Management of Complex Hepato-Pancreato-Biliary Surgery, 2017, p.141-163

Ort / Verlag

Switzerland: Springer International Publishing AG

Erscheinungsjahr

2017

Link zum Volltext

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Surgical management of inferior vena cava tumor thrombosis involves vascular control of the infrahepatic/infrarenal, retrohepatic/suprahepatic/infradiaphragmatic, and supradiaphragmatic inferior vena cava. Standard total vascular exclusion of the liver is indicated for surgery of level III (retrohepatic inferior vena cava and/or hepatic veins involvement) tumor thrombus according to the classification by Neves and Zincke. The duration of liver ischemia can be prolonged by combined portal hypothermic perfusion of the liver. The use of a venovenous bypass during standard total vascular exclusion of the liver maintains stable hemodynamics as well as optimal renal and splanchnic venous drainage. When the hepatic veins can be controlled, total vascular exclusion of the liver preserving the caval flow negates the need for venovenous bypass. We describe here the case of a 66-year-old male patient with a right renal cell carcinoma with a level III tumor thrombus, to illustrate the management of this complex surgical procedure with respect to the intraoperative technical aspects, and to discuss the alternative surgical approaches.