Table 2.
Level III IVC thrombi
| Median/Mean/No. | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Pt No. | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |
| Age (yrs) | 59 | 37 | 72 | 63 | 52 | 72 | 67 | 55 | 51 | 61/59.6 |
| Gender | M | M | M | M | M | F | M | M | M | |
| BMI (kg/m2) | 26.4 | 40 | 27.1 | 22 | 35 | 38 | 28 | 22.5 | 31.5 | 27.5/29.8 |
| ASA® class | III | II | III | III | II | III | III | II | II | |
| Renal tumor: | ||||||||||
| Size (cm) | 8.0 | 9.0 | 8.0 | 10.8 | 5.3 | 6.1 | 10.2 | 9.0 | 7.0 | 8.5/8.3 |
| Side | Rt | Lt | Lt | Lt | Rt | Rt | Rt | Rt | Rt | |
| IVC thrombus length (cm) | 5.0 | 6.0 | 4.1 | 5.4 | 7.0 | 7.0 | 4.0 | 7.0 | 7.0 | 5.7/5.8 |
| Preexisting metastasis | No | No | No | No | No | No | Yes | No | No | |
| Neoadjuvant therapy | Tyrosine kinase inhibitor, 3 mos | No | No | No | No | Prior partial nephrectomy | No | No | No | |
| Preop renal embolization | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | |
| Proximal IVC control level | Intrahepatic | Intrahepatic | Intrahepatic | Intrahepatic | Intrahepatic | Intrahepatic | Intrahepatic | Intrahepatic | Intrahepatic | |
| No. hepatic veins taken | 2 | 2 | 2 | 3 | 3 | 3 | 1 | 2 | 5 | 2/2.6 |
| O.R. time (hrs) | 4.7 | 5.7 | 4.5 | 5.6 | 5.0 | 6.3 | 4.7 | 4.8 | 4.5 | 4.9/5.1 |
| Blood loss (cc) | 200 | 500 | 200 | 800 | 7,000* | 1,300 | 200 | 350 | 200 | 375/493 |
| Blood transfusion | No | No | No | Yes (1 u) | Yes (10 u) | Yes (8 u) | No | No | No | |
| Hospital stay (days) | 22 | 5 | 3 | 3 | 4 | 10 | 5 | 3 | 2 | 4.5/6.8 |
| Intraop complication | No | No | No | No | No* | No | No | No | No | |
| Postop complication | Clavien IIIb† | No | No | No | No | No | No | No | No | |
| Histology | RCC | RCC | RCC | RCC | RCC | RCC | RCC | RCC | RCC | RCC (9) |
| Tumor grade | 3 | 3 | 4 | 3 | 2 | 2 | 3 | 3 | ||
| pTNM stage | T3bNxMx | T3bNxMx | T3bN0M0 | T3bNxMx | T3cN0M0 | T3bN0M0 | T3bN0M1 | T3bN0Mx | T3bNoMx | – |
| Mos followup | 18 | 11 | 8 | 8 | 6 | 2 | 1 | 1 | 1 | 7/7.6 |
| Current status | Alive/NED | Alive/NED | Alive/NED | Alive/NED | Alive/NED | Alive/NED | Alive‡ | Alive/NED | Alive/NED |
*
Patient had a 400 cc blood loss during IVC thrombectomy and radical nephrectomy part of the procedure. Immediately before concluding the procedure, during suctioning of the operative field, a clip on a posterior lumbar vein got dislodged, which was controlled robotically without open conversion, with a 7,000 cc total blood loss.
†
Subphrenic collection developed requiring percutaneous drainage.
‡
Patient underwent excision of large lumbar spinal metastasis 2 weeks after IVC thrombectomy.