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Title: A novel two-stage approach to the treatment of renal cell carcinoma with intra-cardiac tumour extension and Budd-Chiari syndrome.
Austin Authors: Perini, Marcos V ;Ischia, Joseph J ;Woon, Dixon;Bhaskar, Jayapadman;Starkey, Graham M ;Qi, Sara;Wetherell, David ;Ellard, Louise ;McCall, Peter R ;Miles, Lachlan F ;Seevanayagam, Siven 
Affiliation: Surgery (University of Melbourne)
Thoracic Surgery
Victorian Liver Transplant Unit
Vascular Surgery Unit, Austin Health, Melbourne, Victoria, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.;Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia.
Issue Date: 15-Dec-2023
Date: 2023
Publication information: BJU International 2023-12-15
Abstract: 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. The first stage involves transdiaphragmatic debulking of the right heart, inferior vena cava (IVC) 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 IVC and vascular reconstruction via an abdominal incision. Three of five patients presented with clinical Budd-Chiari syndrome; two had radiological features only. The median time between surgical procedures was 12 days (IQR 13 days). 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. 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 programme of surgery.
DOI: 10.1111/bju.16257
ORCID: 0000-0002-0165-1564
Journal: BJU International
PubMed URL: 38102752
ISSN: 1464-410X
Type: Journal Article
Subjects: Budd-Chiari
deep hypothermic circulatory arrest
hepatic veins
inferior vena cava graft
liver cold perfusion
liver failure
renal cell carcinoma
surgical technique
tumour thrombus
Appears in Collections:Journal articles

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