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Assessment of short-term outcomes of radical nephrectomy combined with IVC thrombectomy with a novel technique without thoracotomy: single center case series.
Assessment of the 30-day mortality and major complications as well as long-term oncological outcomes of three patients undergoing radical nephrectomy combined with inferior vena cava (IVC) thrombectomy with a novel technique without thoracotomy for renal cell carcinoma with IVC level IV thrombus. This is a retrospective case series carried out at Attikon University Hospital between January 2018 to March 2020.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Transabdominal inferior vena cava thrombectomy | Patients undergoing radical nephrectomy and inferior vena cava thrombectomy transabdominal without thoracotomy |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Radical nephrectomy with inferior vena cava thrombectomy without thoracotomy | Procedure | The abdomen was accessed through a Makuuchi incision. After mobilization of the liver and assessment of the inferior vena cava infiltration (IVC), IVC was clamped below the level of the renal veins. In order to get access to the intrapericardial IVC, an incision was made through the tendon of the diaphragm and a clamp was placed first in the hepatoduodenal ligament (Pringle maneuver) and then in the endopericardial portion of the IVC, in that order. A longitudinal 3-4 cm incision was made incorporating the junction of IVC and right renal vein. After tumor removal thrombus was removed and a fine clamp was placed at the IVC just below the hepatocaval junction and immediate release of the clamping of the hepatoduodenal ligament. Total endopericardial clamp time was 4 minutes. Patients then underwent radical nephrectomy in a standard fashion with en bloc resection of the IVC thrombus. |
| Measure | Description | Time Frame |
|---|---|---|
| Short term mortality rate | Percentage of patients' postoperative deaths | 30 days |
| Measure | Description | Time Frame |
|---|---|---|
| Short term major complications' rate | Incidence of Clavien/Dindo grade 3 or more postoperative complications | 30 days |
| Recurrence rate | Rate of local or systemic recurrence |
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Inclusion Criteria:
Exclusion Criteria:
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Among all patients with renal cell carcinoma operated in Attikon University Hospital, the ones with level IV tumor thrombus were included in the study.
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| Name | Affiliation | Role |
|---|---|---|
| Nikolaos Arkadopoulos, MD, PhD | Attikon Hospital | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Attikon University Hospital | Chaïdári | 12462 | Greece |
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| ID | Term |
|---|---|
| D002292 | Carcinoma, Renal Cell |
| ID | Term |
|---|---|
| D000230 | Adenocarcinoma |
| D002277 | Carcinoma |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009370 | Neoplasms by Histologic Type |
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| ID | Term |
|---|---|
| D013908 | Thoracotomy |
| ID | Term |
|---|---|
| D019616 | Thoracic Surgical Procedures |
| D013514 | Surgical Procedures, Operative |
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|
| 27 months |
| D009369 | Neoplasms |
| D007680 | Kidney Neoplasms |
| D014571 | Urologic Neoplasms |
| D014565 | Urogenital Neoplasms |
| D009371 | Neoplasms by Site |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052801 | Male Urogenital Diseases |