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Definition:
Some larger kidney cancers are associated with a growth
pattern in which part of the tumor (known as a tumor thrombus) grows
into the renal vein. This type of growth pattern occurs in 5-7%
of patients with kidney cancer, and growth pattern requires a unique
operation to safely remove the entire kidney cancer. The operation
is the same as an open radical nephrectomy, but it also involves
the surgeon opening the main vein inside the abdomen (which is known
as the vena caval) to remove the tumor thrombus that has clogged
this vein.
Technique:
Open radical
nephrectomy with vena caval thrombectomy is a procedure that should
be done only by specially trained surgeons who often work in collaboration
with teams of other surgeons (vascular surgeons and heart surgeons)
to perform this challenging operation. Open radical nephrectomy
with vena caval thrombectomy requires exquisite attention to detail
as it is a high risk operation. This surgery is performed through
a large flank or abdominal incision and may require simultaneous
open heart surgery to successfully remove all of the cancer.
During the operation, the kidney is detached and the
vena caval is opened to extract the portions of the tumor that have
clogged this vein. This may require that the patient’s heart
be temporarily stopped to adequately remove all of the cancer. Due
to the extremely complex nature of the operation and because of
the high risk to the patient, it is extremely important to be counseled
and treated in a multidisciplinary surgical environment in which
an experienced urologist specially trained in cancer surgery of
this type works with a heart surgeon, and a vascular surgeon to
maximize the patient’s chance to have this procedure done successfully.
Candidates:
The ideal candidate for a radical nephrectomy with vena
caval thrombectomy includes otherwise healthy patients with kidney
cancer that is limited to the kidney area and with a growth of the
kidney cancer into the vena caval (kidney cancer thrombus). Before
undergoing this type of surgery, patients should discuss their situation
with a Urologist that has extensive training and experience with
this type of surgery in great detail.
Follow-up
Cure rates following successful radical nephrectomy with
vena caval thrombetomy can be as high as 40 to 60% for this advanced
form of kidney cancer. Follow-up in this situation often involves
treatment in a multidisciplinary cancer center using the state of
art systemic or total body therapies.
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