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

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Case-Based Lessons in the Management of Complex Hepato-Pancreato-Biliary Surgery

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Abstract

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.

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Authors and Affiliations

  1. Department of HPB Surgery and Liver Transplant Unit, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Creteil, 94010, France

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

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  1. Chetana Lim
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  2. Chady Salloum
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  3. Eylon Lahat
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  4. Michael Ossesis
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  5. Concepcion Gomez Gavara
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  6. Philippe Compagnon
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  7. Daniel Azoulay
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Correspondence to Daniel Azoulay .

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Editors and Affiliations

  1. The Ohio State Wexner Medical Center , The Ohio State University School of Medicine , Columbus, Ohio, USA

    Timothy M. Pawlik

  2. Division of General Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA

    Sharon Weber

  3. Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    T. Clark Gamblin

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Lim, C. et al. (2017). Resection of Renal Cell Carcinoma Involving the Liver with Tumor Thrombus Extending into Inferior Vena Cava Requiring Venovenous Bypass. In: Pawlik, T., Weber, S., Gamblin, T. (eds) Case-Based Lessons in the Management of Complex Hepato-Pancreato-Biliary Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-50868-9_11

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  • DOI: https://doi.org/10.1007/978-3-319-50868-9_11

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  • Print ISBN: 978-3-319-50867-2

  • Online ISBN: 978-3-319-50868-9

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