The use of liver transplant techniques to aid in the surgical management of urological tumors

Purpose: Inferior vena cava tumor thrombus complicates radical nephrectomy. Various approaches have been used to deal with this problem, including ven ovenous and cardiopulmonary bypass. Applying organ transplant techniques en hances the exposure of urological tumors and may avoid bypass. Materials and Methods: A total of 26 patients underwent surgery by techniqu es developed to facilitate orthotopic liver transplantation. Of the patient s 15 with renal cell carcinoma and an intracaval tumor thrombus underwent p iggyback style mobilization of the liver off of the retrohepatic inferior v ena cava to allow enhanced access and vascular control, while 11 underwent conventional mobilization of the liver and retrohepatic inferior vena cava en bloc to allow enhanced access to various renal, adrenal and retroperiton eal tumors. Results: In the 11 patients surgery was successful with a median blood loss of 200 mi. Postoperative ileus in 1 case was the only complication. We res ected 5 infrahepatic thrombi without complications and with a median blood loss of 500 mi. In 7 patients with a retrohepatic inferior vena caval throm bus median blood loss was 1,500 mi., including 1 who died postoperatively, presumably due to a massive pulmonary embolus. Caval atrial tumor thrombus in 3 cases was successfully removed via a completely abdominal approach and sternotomy in 2. Cardiopulmonary bypass with hypothermic circulatory arres t was required in 1 of these cases. Conclusions: Liver mobilization was helpful for managing difficult urologic al tumors. Patients with a retrohepatic or even suprahepatic inferior vena caval thrombus may be treated without sternotomy or thoracotomy and cardiop ulmonary bypass.