Laparoscopic Vena Cava Thrombectomy and Radical Nephrectomy in a Malignant Pheochromocytoma Case

Authors

  • Tito Palmela Leitão Univerdade de Lisboa - Faculdade de Medicina http://orcid.org/0000-0002-0075-6196
  • Miguel Miranda Centro Hospitalar Universitário Lisboa Norte https://orcid.org/0000-0002-5179-4491
  • Tiago Oliveira Centro Hospitalar Universitário Lisboa Norte http://orcid.org/0000-0003-3196-1886
  • Pedro Oliveira Centro Hospitalar Universitário Lisboa Norte
  • Inês Pereira Pereira Centro Hospitalar Universitário Lisboa Norte
  • José Palma dos Reis Univerdade de Lisboa - Faculdade de Medicina
  • Isabel Fernandes Univerdade de Lisboa - Faculdade de Medicina
  • Lucindo Ormonde Univerdade de Lisboa - Faculdade de Medicina
  • Luis Costa Univerdade de Lisboa - Faculdade de Medicina https://orcid.org/0000-0002-4782-7318
  • Luis Mendes Pedro Univerdade de Lisboa - Faculdade de Medicina
  • Tomé Lopes Univerdade de Lisboa - Faculdade de Medicina

DOI:

https://doi.org/10.24915/aup.37.1-2.162

Keywords:

Pheochromocytoma, Laparoscopy, Nephrectomy, Robotic Surgical Procedures, Thrombectomy, Vena Cava, Inferior

Abstract

Pheochromocytomas with vena cava thrombus are extremely rare, with only a few cases reported in the literature. Radical nephrectomy with adrenalectomy and inferior vena cava (IVC) thrombectomy is the treatment of choice. However, it is a challenging procedure and its surgical approach is yet to be standardized. We present a case of a 49-year-old male incidentally diagnosed with a pheochromocytoma with aggressive local invasion and a level 1 vena cava thrombus. A laparoscopic right radical nephrectomy with right adrenalectomy, IVC thrombectomy and cavorraphy. A detailed revision of the technique is performed and compared with current strategies for pheochromocytoma optimal treatment. Renal and adrenal masses with vena cava thrombus are associated with high morbidity and mortality, particularly in the case of pheochromocytoma. The management is complex but minimally invasive surgery can be performed safely in the context of an experienced multidisciplinary team.

Downloads

Download data is not yet available.

Author Biography

Tito Palmela Leitão, Univerdade de Lisboa - Faculdade de Medicina

Urology

References

Ljungberg B, Albiges L, Bensalah K, Bex A, Giles RH, Hora M, et al. EAU Guidelines on Renal Cell Carcinoma. Arnhem: European Asso- ciation of Urology, EAU Guidelines Office; 2020.

Abaza R, Shabsigh A, Castle E, Allaf M, Hu JC, Rogers C, et al. Multiinstitutional experience with robotic nephrectomy with inferior vena cava tumor thrombectomy. J Urol. 2016;195865-871. doi: 10.1016/ j.juro.2015.09.094.

Liu Z, Zhao X, Ge L, Wu B, Tang S, Hong P, et al. Completely laparoscopic versus open radical nephrectomy and infrahepatic tumor thrombectomy: Comparison of surgical complexity and prognosis. Asian J Surg. 2021;44:641-8. doi: 10.1016/j.asjsur.2020.12. 003.

Farrugia FA, Charalampopoulos A. Pheochromocytoma. Endocr Regul. 2019;53:191-212.

Li J, Wang Y, Chang X, Han Z. Laparoscopic adrenalectomy (LA) vs open adrenalectomy (OA) for pheochromocytoma (PHEO): A systematic review and meta-analysis. Eur J Surg Oncol. 2020;46:991-8.

Nel D, Panieri E, Malherbe F, Steyn R, Cairncross L. Surgery for Pheochromocytoma: A Single-Center Review of 60 Cases from South Africa. World J Surg. 2020;44:1918-24.

Bihain F, Klein M, Nomine-Criqui C, Brunaud L. Robotic adrenalectomy in patients with pheochromocytoma: a systematic review. Gland Surg. 2020;9:844-8.

Aggeli C, Nixon AM, Parianos C, Vletsis G, Papanastasiou L, Markou A, et al. Surgery for pheochromocytoma: A 20-year experience of a single institution. Hormones. 2017;4:388-395.

Chen J, Liu C, Liu C, Fu Q, Pei D, Ren L, et al. Anesthetic management of gigantic pheochromocytoma resection with inferior vena cava and right atrium tumor thrombosis: a case report. BMC Anesthesiol. 2019; 19:71. doi: 10.1186/s12871-019-0742-6.

Geelhoed GW, Dunnick NR, Doppman JL. Management of intravenous extensions of endocrine tumors and prognosis after surgical treatment. Am J Surg. 1980;139:844-8.

Shigemura K, Tanaka K, Arakawa S, Hara I, Kawabata G, Fujisawa M. Malignant pheochromocytoma with IVC thrombus. Int Urol Nephrol. 2007;39:103-6.

Kota SK, Kota SK, Jammula S, Meher LK, Modi KD. Pheochromocytoma with inferior vena cava thrombosis: An unusual association. J Cardiovasc Dis Res. 2012;3:160-4.

Gregory SH, Yalamuri SM, McCartney SL, Shah SA, Sosa JA, Roman S, et al. Perioperative management of adrenalectomy and inferior vena cava reconstruction in a patient with a large, malignant pheochromocytoma with vena caval extension. J Cardiothorac Vasc Anesth. 2017;31:365-77. doi: 10.1053/j.jvca.2016.07.019.

Jia Z, Wang BJ, Li X, Zhang X. Pheochromocytoma with delayed tumor thrombus detection in renal vein: A case report. World J Clin Cases. 2020;8:2849-54.

Moinzadeh A, Libertino JA. Prognostic significance of tumor thrombus level in patients with renal cell carcinoma and venous tumor thrombus extension. Is all T3b the same? J Urol. 2004;171:598-601.

Lardas M, Stewart F, Scrimgeour D. Systematic Review of surgical management of nonmetastatic renal cell carcinoma with vena caval thrombus. Eur Urol. 2016;70:265-80.

Savage SJ, Gill IS. Laparoscopic radical nephrectomy for renal cell carcinoma in a patient with level I renal vein tumor thrombus. J Urol. 2000;163:1243-4.

Shao P, Li J, Qin C, Lv Q, Ju X, Li P, et al. Laparoscopic radical nephrectomy and inferior vena cava thrombectomy in the treatment of renal cell carcinoma. Eur Urol. 2015;68:115-22. doi: 10.1016/ j.eururo.2014.12.011.

Sundaram CP, Rehman J, Landman J, Oh J. Hand assisted laparoscopic radical nephrectomy for renal cell carcinoma with inferior vena caval thrombus. J Urol. 2002;168:176-9.

Blute ML, Boorjian SA, Leibovich BC, Lohse CM, Frank I, Karnes RJ. Results of inferior vena caval interruption by greenfield filter, ligation or resection during radical nephrectomy and tumor thrombectomy. J Urol. 2007;178:440-5; discussion 444.

Woodruff DY, Van Veldhuizen P, Muehlebach G, Johnson P, Williamson T, Holzbeierlein JM. The perioperative management of an inferior vena caval tumor thrombus in patients with renal cell carcinoma. Urol Oncol. 2013;31:517-21.

Tohi Y, Makita N, Suzuki I, Suzuki R, Kubota M, Sugino Y, et al. En bloc laparoscopic radical nephrectomy with inferior vena cava thrombectomy: A single-institution experience. Int J Urol. 2019;26:363-8.

Chopra S, Simone G, Metcalfe C, de Castro Abreu AL, Nabhani J, Ferriero M, et al. Robot-assisted Level II-III Inferior Vena Cava Tumor Thrombectomy: Step-by-Step Technique and 1-Year Outcomes. Eur Urol. 2017;72:267-74.

Wang B, Li H, Ma X, Zhang X, Gu L, Li X, et al. Robot-assisted laparoscopic inferior vena cava thrombectomy: different sides require different techniques. Eur Urol. 2016;69:1112-9. doi: 10.1016/ j.eururo.2015.12.001.

Fu SQ, Wang SY, Chen Q, Liu YT, Li ZL, Sun T. Laparoscopic versus open surgery for pheochromocytoma: a meta-analysis. BMC Surg. 2020;20:167. doi: 10.1186/s12893-020-00824-6.

Published

2022-01-26