Retrohepatic inferior vena cava control through an anterior approach in cases of renal cell carcinoma with level IIIa tumor thrombus: Step-by-step description

To evaluate the safety and efficacy of the retrohepatic inferior vena cava control through an anterior approach (RIVCA) technique in renal cell carcinoma (RCC) with level IIIa tumor thrombus. Initial series of 6 cases presenting RCC and level IIIa tumor thrombus who underwent radical nephrectomy and tumor thrombectomy using the RIVCA technique between 2018–2019. RIVCA technique aims to gain complete control of the retrohepatic inferior vena cava above the cranial end of the tumor thrombus, but excluding the major hepatic veins in order to preserve the natural hepato-caval shunt. A step-by-step description of the procedure is provided. Disease features, operative characteristics, and surgical outcomes were registered prospectively. Radical nephrectomy and tumor thrombectomy were completed in all cases. RIVCA technique did not increase operative time significantly (range: 14–22 min). Mean estimated blood loss was 325 cc (range: 250–400). Blood transfusion was not required intraoperatively in any of the cases. Mean postoperative transfusion rate was 1.3 red blood cells packed units (range: 0–2). There were no cases of intraoperative pulmonary embolism or major complications (Clavien-Dindo III-V) in the period of 30 days postoperatively. Median postoperative length of stay was 8 days (range: 5–11). The RIVCA technique applied to cases of RCC and level IIIa tumor thrombus provides complete control of the retrohepatic inferior vena cava above the tumor thrombus cranial end, while prevents intraoperative hemodynamic instability by maintaining cardiac preload through the porto-caval shunt. This technique may limit operative morbidity (intraoperative pulmonary embolism and massive hemorrhage), thus becoming a helpful adjunct to be used in cases of RCC with level IIIa tumor thrombus. Evaluar la seguridad y eficacia de la técnica de control de la vena cava inferior retrohepática por acceso anterior (RIVCA, por retrohepatic inferior vena cava control through an anterior approach) en el carcinoma de células renales (CCR) con trombo tumoral nivel IIIa. Serie inicial de 6 casos que presentan CCR con trombo tumoral nivel IIIa intervenidos de nefrectomía radical y trombectomía tumoral mediante la técnica RIVCA entre 2018–2019. El objetivo de la técnica RIVCA es obtener un control completo de la vena cava inferior retrohepática por encima de la porción craneal del trombo tumoral, pero excluyendo las venas hepáticas mayores con el fin de preservar la circulación hepatocava n