Resection of Inferior Vena Cava Without Reconstruction for Intravascular Intrusion of Wilms Tumor

Persistent inferior vena cava (IVC) tumor thrombus in Wilms tumor patients represents a management challenge. We describe three pediatric cases with preoperative evaluation documenting complete IVC occlusion and well-developed collaterals. They underwent nephrectomy and tumor thrombus removal accomp...

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Bibliographic Details
Published in:Urology (Ridgewood, N.J.) N.J.), 2021-03, Vol.149, p.e29-e33
Main Authors: Ceccanti, Silvia, Büyükünal, Cenk, Emre, Şenol, Masselli, Gabriele, Schiavetti, Amalia, Cozzi, Denis A
Format: Article
Language:English
Subjects:
Carcinoma, Renal Cell - pathology
Carcinoma, Renal Cell - surgery
Child
Child, Preschool
Female
Humans
Male
Neoplastic Cells, Circulating
Nephrectomy
Vena Cava, Inferior
Wilms Tumor - secondary
Wilms Tumor - surgery
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Description
Summary:Persistent inferior vena cava (IVC) tumor thrombus in Wilms tumor patients represents a management challenge. We describe three pediatric cases with preoperative evaluation documenting complete IVC occlusion and well-developed collaterals. They underwent nephrectomy and tumor thrombus removal accomplished with circumferential resection of the retrohepatic IVC without vascular reconstruction. All patients are asymptomatic and disease-free at 9, 2.5, and 2 years after stopping therapy. Cavectomy without reconstruction is safe and well tolerated in Wilms tumor patients with completely occlusive IVC tumor thrombus. Additionally, when performed en bloc with nephrectomy and with clear margins, cavectomy obviates the need for radiotherapy per protocol.
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2020.11.004