Incidence, Histology, And Management Of Intraluminal Thrombus At Post-Chemotherapy Retroperitoneal Lymph Node Dissection

Abstract

Purpose

We determined the incidence, histology and management of intraluminal thrombi in a large group of patients undergoing PC RPLND

Materials and Methods

The Indiana University testicular cancer database was queried from January 1990 to June 2010. Two-hundred and forty patients required resection of tumor en bloc with major vasculature and/or thrombectomy at PC RPLND. Of these, 89 patients had 98 intraluminal thrombi involving major vasculature.

Results

Location of the 98 thrombi included IVC in 72, Aorta in 1, Renal vein in 20. Management of the 72 caval thrombi included cavectomy in 36, partial cavectomy in 9 and thrombectomy in 27. Of the 20 renal vein thrombi, management included nephrectomy in 18 and thrombectomy in 2. The single aortic thrombus was managed with aortic resection and replacement. Pathology revealed bland thrombi in 31, necrosis in 23, teratoma in 28, active germ cell cancer in 12 and sarcoma in 4. Forty patients required 71 additional procedures, including32 nephrectomy, 6 liver resection, 7 bowel resection, 6 thoracotomy, 3 vertebral resection,11 orchiectomy, 1 duodenal repair, 1 ureteroureterotomy, 1 stent removal, 1 cholecystectomy, 1 appendectomy, 1 paraspinal tumor removal. Eleven patients had 17 Clavien III or worse complications, including 2 deaths. Average EBL 1165 (Range 200-7000), average hospital stay 9.3 days (2-70).

Conclusions

The incidence of intraluminal thrombi at PC RPLND is 5.8%, and cancer pathology was observed in 44.9%. Surgeons undertaking PC RPLND should be well-versed in vascular techniques with respect to major vasculature.

http://www.jurology.com/article/S0022-5347(13)03686-0/abstract