A Novel Two‐stage Approach to the Treatment of RCC with Intra‐Cardiac Tumour Extension and Budd‐Chiari Syndrome
Marcos V. Perini, Joseph Ischia, Dixon Woon, Jayapadman Bhaskar, Graham Starkey, Sara Qi, David Wetherell, Louise Ellard, Peter McCall, Lachlan F. Miles, Siven Seevanayagam - Urology
Objective
To present the early results of a new technique for the treatment of renal cell carcinoma with intra‐cardiac tumour extension and Budd‐Chiari Syndrome.
Patient and Methods
The first stage involves transdiaphragmatic debulking of the right heart, inferior vena cava and hepatic veins via median sternotomy, followed by a purse string suture placed in the IVC below the hepatic veins. The second stage is performed separately and involves en bloc resection of the affected kidney and inferior vena cava and vascular reconstruction via an abdominal incision.
Results
Three of the five patients presented with clinical Budd‐Chiari syndrome; two had radiological features only. The median time between the surgical procedures was 13.2 days (8‐28days). Four of the five patients had a R0 resection. While all five patients successfully completed both operative stages, one patient died 22 days after the second stage. Of the remaining four, all survive with no disease recurrence.
Conclusions
While we continue to compile longer‐term data for a larger follow‐up series, these preliminary findings show the feasibility of this technique and support the development of this program of surgery.