Radical nephrectomy and inferior vena caval thrombectomy: Outcomes in a lower volume practice

John B. Calhoun, Todd David Merchen, James A. Brown

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction: Surgical volume correlates with improved outcomes for some complex urologic procedures. We reviewed the outcomes of a lower volume practice (1-2 cases per year) experience with radical nephrectomy with infra/retrohepatic vena caval thrombectomy (RNCT). Methods: We retrospectively reviewed 10 patients who underwent RNCT performed by a single surgeon at a single state institution over 7 years (2002-2009). Patient demographics, presenting symptoms, preoperative imaging, intraoperative findings, pathology, hospital course, outcomes, level of caval involvement, renal artery embolization, liver mobilization, blood loss, transfusion requirements and follow up times were recorded. Results: Median patient BMI (n = 8) was 25.7 (18.3-31.9). Eight patients underwent renal artery embolization prior to RNCT. A vascular or liver surgeon assisted in all 10 RNCT cases. Six thrombi were infrahepatic and four were retrohepatic requiring liver mobilization. Median operative time was 340 minutes (220-480) with a median vena cava clamp time of 17 minutes (11-22). Eight (80%) patients required intraoperative transfusion. Median pathologic tumor size was 9.5 cm (range 6-21). Median hospital stay was 7.5 days (5-15). Four patients had complications including colonic mesenteric rent (n = 2), abscess (n = 1), retroperitoneal hematoma (n = 1), distal pancreatic injury (n = 1), and splenic capsular tear (n = 1). One patient had postoperative liver metastasis. Two patients died from postoperative metastasis, at 5 months and 11 months. Conclusions: RNCT can be performed, with the assistance of a vascular/liver transplant surgeon, for an infrahepatic or retrohepatic thrombus satisfactorily in a lower volume practice.

Original languageEnglish (US)
Pages (from-to)5537-5541
Number of pages5
JournalCanadian Journal of Urology
Volume18
Issue number1
StatePublished - Dec 1 2011

Fingerprint

Thrombectomy
Venae Cavae
Nephrectomy
Liver
Renal Artery
Blood Vessels
Thrombosis
Neoplasm Metastasis
Operative Time
Tears
Blood Transfusion
Hematoma
Abscess
Length of Stay
Demography
Pathology
Transplants
Wounds and Injuries

Keywords

  • Carcinoma
  • Health facility size
  • Nephrectomy
  • Renal cell
  • Thrombectomy
  • Vena cavae

ASJC Scopus subject areas

  • Urology

Cite this

Radical nephrectomy and inferior vena caval thrombectomy : Outcomes in a lower volume practice. / Calhoun, John B.; Merchen, Todd David; Brown, James A.

In: Canadian Journal of Urology, Vol. 18, No. 1, 01.12.2011, p. 5537-5541.

Research output: Contribution to journalArticle

@article{b6b490ecd7aa4d22bfa36c7c42cf5443,
title = "Radical nephrectomy and inferior vena caval thrombectomy: Outcomes in a lower volume practice",
abstract = "Introduction: Surgical volume correlates with improved outcomes for some complex urologic procedures. We reviewed the outcomes of a lower volume practice (1-2 cases per year) experience with radical nephrectomy with infra/retrohepatic vena caval thrombectomy (RNCT). Methods: We retrospectively reviewed 10 patients who underwent RNCT performed by a single surgeon at a single state institution over 7 years (2002-2009). Patient demographics, presenting symptoms, preoperative imaging, intraoperative findings, pathology, hospital course, outcomes, level of caval involvement, renal artery embolization, liver mobilization, blood loss, transfusion requirements and follow up times were recorded. Results: Median patient BMI (n = 8) was 25.7 (18.3-31.9). Eight patients underwent renal artery embolization prior to RNCT. A vascular or liver surgeon assisted in all 10 RNCT cases. Six thrombi were infrahepatic and four were retrohepatic requiring liver mobilization. Median operative time was 340 minutes (220-480) with a median vena cava clamp time of 17 minutes (11-22). Eight (80{\%}) patients required intraoperative transfusion. Median pathologic tumor size was 9.5 cm (range 6-21). Median hospital stay was 7.5 days (5-15). Four patients had complications including colonic mesenteric rent (n = 2), abscess (n = 1), retroperitoneal hematoma (n = 1), distal pancreatic injury (n = 1), and splenic capsular tear (n = 1). One patient had postoperative liver metastasis. Two patients died from postoperative metastasis, at 5 months and 11 months. Conclusions: RNCT can be performed, with the assistance of a vascular/liver transplant surgeon, for an infrahepatic or retrohepatic thrombus satisfactorily in a lower volume practice.",
keywords = "Carcinoma, Health facility size, Nephrectomy, Renal cell, Thrombectomy, Vena cavae",
author = "Calhoun, {John B.} and Merchen, {Todd David} and Brown, {James A.}",
year = "2011",
month = "12",
day = "1",
language = "English (US)",
volume = "18",
pages = "5537--5541",
journal = "Canadian Journal of Urology",
issn = "1195-9479",
publisher = "Canadian Journal of Urology",
number = "1",

}

TY - JOUR

T1 - Radical nephrectomy and inferior vena caval thrombectomy

T2 - Outcomes in a lower volume practice

AU - Calhoun, John B.

AU - Merchen, Todd David

AU - Brown, James A.

PY - 2011/12/1

Y1 - 2011/12/1

N2 - Introduction: Surgical volume correlates with improved outcomes for some complex urologic procedures. We reviewed the outcomes of a lower volume practice (1-2 cases per year) experience with radical nephrectomy with infra/retrohepatic vena caval thrombectomy (RNCT). Methods: We retrospectively reviewed 10 patients who underwent RNCT performed by a single surgeon at a single state institution over 7 years (2002-2009). Patient demographics, presenting symptoms, preoperative imaging, intraoperative findings, pathology, hospital course, outcomes, level of caval involvement, renal artery embolization, liver mobilization, blood loss, transfusion requirements and follow up times were recorded. Results: Median patient BMI (n = 8) was 25.7 (18.3-31.9). Eight patients underwent renal artery embolization prior to RNCT. A vascular or liver surgeon assisted in all 10 RNCT cases. Six thrombi were infrahepatic and four were retrohepatic requiring liver mobilization. Median operative time was 340 minutes (220-480) with a median vena cava clamp time of 17 minutes (11-22). Eight (80%) patients required intraoperative transfusion. Median pathologic tumor size was 9.5 cm (range 6-21). Median hospital stay was 7.5 days (5-15). Four patients had complications including colonic mesenteric rent (n = 2), abscess (n = 1), retroperitoneal hematoma (n = 1), distal pancreatic injury (n = 1), and splenic capsular tear (n = 1). One patient had postoperative liver metastasis. Two patients died from postoperative metastasis, at 5 months and 11 months. Conclusions: RNCT can be performed, with the assistance of a vascular/liver transplant surgeon, for an infrahepatic or retrohepatic thrombus satisfactorily in a lower volume practice.

AB - Introduction: Surgical volume correlates with improved outcomes for some complex urologic procedures. We reviewed the outcomes of a lower volume practice (1-2 cases per year) experience with radical nephrectomy with infra/retrohepatic vena caval thrombectomy (RNCT). Methods: We retrospectively reviewed 10 patients who underwent RNCT performed by a single surgeon at a single state institution over 7 years (2002-2009). Patient demographics, presenting symptoms, preoperative imaging, intraoperative findings, pathology, hospital course, outcomes, level of caval involvement, renal artery embolization, liver mobilization, blood loss, transfusion requirements and follow up times were recorded. Results: Median patient BMI (n = 8) was 25.7 (18.3-31.9). Eight patients underwent renal artery embolization prior to RNCT. A vascular or liver surgeon assisted in all 10 RNCT cases. Six thrombi were infrahepatic and four were retrohepatic requiring liver mobilization. Median operative time was 340 minutes (220-480) with a median vena cava clamp time of 17 minutes (11-22). Eight (80%) patients required intraoperative transfusion. Median pathologic tumor size was 9.5 cm (range 6-21). Median hospital stay was 7.5 days (5-15). Four patients had complications including colonic mesenteric rent (n = 2), abscess (n = 1), retroperitoneal hematoma (n = 1), distal pancreatic injury (n = 1), and splenic capsular tear (n = 1). One patient had postoperative liver metastasis. Two patients died from postoperative metastasis, at 5 months and 11 months. Conclusions: RNCT can be performed, with the assistance of a vascular/liver transplant surgeon, for an infrahepatic or retrohepatic thrombus satisfactorily in a lower volume practice.

KW - Carcinoma

KW - Health facility size

KW - Nephrectomy

KW - Renal cell

KW - Thrombectomy

KW - Vena cavae

UR - http://www.scopus.com/inward/record.url?scp=79959779913&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79959779913&partnerID=8YFLogxK

M3 - Article

C2 - 21333047

AN - SCOPUS:79959779913

VL - 18

SP - 5537

EP - 5541

JO - Canadian Journal of Urology

JF - Canadian Journal of Urology

SN - 1195-9479

IS - 1

ER -