Incidence, histology and management of intraluminal thrombus at post-chemotherapy retroperitoneal lymph node dissection

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose: We determined the incidence, histology and management of intraluminal thrombus in a large group of patients treated with post-chemotherapy retroperitoneal lymph node dissection. Materials and Methods: We queried the testicular cancer database at our institution from January 1990 to June 2010. Tumor resection en bloc with major vascular structures and/or thrombectomy at post-chemotherapy retroperitoneal lymph node dissection was done in 240 patients, of whom 89 had a total of 98 intraluminal thrombi involving major vasculature. Results: The site of the 98 thrombi was the inferior vena cava (72), aorta (1) and renal vein (20). Management of the 72 vena caval thrombi included cavectomy (36), partial cavectomy (9) and thrombectomy (27). For the 20 renal vein thrombi management included nephrectomy (18) and thrombectomy (2). The single aortic thrombus was managed by aortic resection and replacement. Pathological evaluation revealed bland thrombi in 31 cases, necrosis in 23, teratoma in 28, active germ cell cancer in 12 and sarcoma in 4. In 40 patients a total of 71 additional procedures were required, including nephrectomy in 32, liver resection in 6, bowel resection in 7, thoracotomy in 6, vertebral resection in 3, orchiectomy in 11, and duodenal repair, ureteroureterotomy, stent removal, cholecystectomy, appendectomy and paraspinal tumor removal in 1 each. There were 17 Clavien III or worse complications in a total of 11 patients, including 2 deaths. Average estimated blood loss was 1,165 ml (range 200 to 7,000) and average hospital stay was 9.3 days (range 2 to 70). Conclusions: The incidence of intraluminal thrombus at post-chemotherapy retroperitoneal lymph node dissection is 5.8%. Cancer pathology was observed in 44.9% of cases. Surgeons who perform post-chemotherapy retroperitoneal lymph node dissection should be well versed in vascular techniques with respect to the major vasculature.

Original languageEnglish (US)
Pages (from-to)874-877
Number of pages4
JournalJournal of Urology
Volume190
Issue number3
DOIs
StatePublished - Sep 1 2013

Fingerprint

Lymph Node Excision
Histology
Thrombosis
Drug Therapy
Incidence
Thrombectomy
Renal Veins
Nephrectomy
Blood Vessels
Neoplasms
Venae Cavae
Appendectomy
Orchiectomy
Germ Cell and Embryonal Neoplasms
Midazolam
Teratoma
Testicular Neoplasms
Inferior Vena Cava
Cholecystectomy
Thoracotomy

Keywords

  • blood supply
  • lymph node excision
  • testicular neoplasms
  • testis
  • thrombosis

ASJC Scopus subject areas

  • Urology

Cite this

@article{02d0914c64cf4238b83f412adbe499bd,
title = "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 thrombus in a large group of patients treated with post-chemotherapy retroperitoneal lymph node dissection. Materials and Methods: We queried the testicular cancer database at our institution from January 1990 to June 2010. Tumor resection en bloc with major vascular structures and/or thrombectomy at post-chemotherapy retroperitoneal lymph node dissection was done in 240 patients, of whom 89 had a total of 98 intraluminal thrombi involving major vasculature. Results: The site of the 98 thrombi was the inferior vena cava (72), aorta (1) and renal vein (20). Management of the 72 vena caval thrombi included cavectomy (36), partial cavectomy (9) and thrombectomy (27). For the 20 renal vein thrombi management included nephrectomy (18) and thrombectomy (2). The single aortic thrombus was managed by aortic resection and replacement. Pathological evaluation revealed bland thrombi in 31 cases, necrosis in 23, teratoma in 28, active germ cell cancer in 12 and sarcoma in 4. In 40 patients a total of 71 additional procedures were required, including nephrectomy in 32, liver resection in 6, bowel resection in 7, thoracotomy in 6, vertebral resection in 3, orchiectomy in 11, and duodenal repair, ureteroureterotomy, stent removal, cholecystectomy, appendectomy and paraspinal tumor removal in 1 each. There were 17 Clavien III or worse complications in a total of 11 patients, including 2 deaths. Average estimated blood loss was 1,165 ml (range 200 to 7,000) and average hospital stay was 9.3 days (range 2 to 70). Conclusions: The incidence of intraluminal thrombus at post-chemotherapy retroperitoneal lymph node dissection is 5.8{\%}. Cancer pathology was observed in 44.9{\%} of cases. Surgeons who perform post-chemotherapy retroperitoneal lymph node dissection should be well versed in vascular techniques with respect to the major vasculature.",
keywords = "blood supply, lymph node excision, testicular neoplasms, testis, thrombosis",
author = "Paul Johnston and Beck, {Stephen D.W.} and Liang Cheng and Masterson, {Timothy A.} and Richard Bihrle and Kenneth Kesler and Foster, {Richard S.}",
year = "2013",
month = "9",
day = "1",
doi = "10.1016/j.juro.2013.03.039",
language = "English (US)",
volume = "190",
pages = "874--877",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Incidence, histology and management of intraluminal thrombus at post-chemotherapy retroperitoneal lymph node dissection

AU - Johnston, Paul

AU - Beck, Stephen D.W.

AU - Cheng, Liang

AU - Masterson, Timothy A.

AU - Bihrle, Richard

AU - Kesler, Kenneth

AU - Foster, Richard S.

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Purpose: We determined the incidence, histology and management of intraluminal thrombus in a large group of patients treated with post-chemotherapy retroperitoneal lymph node dissection. Materials and Methods: We queried the testicular cancer database at our institution from January 1990 to June 2010. Tumor resection en bloc with major vascular structures and/or thrombectomy at post-chemotherapy retroperitoneal lymph node dissection was done in 240 patients, of whom 89 had a total of 98 intraluminal thrombi involving major vasculature. Results: The site of the 98 thrombi was the inferior vena cava (72), aorta (1) and renal vein (20). Management of the 72 vena caval thrombi included cavectomy (36), partial cavectomy (9) and thrombectomy (27). For the 20 renal vein thrombi management included nephrectomy (18) and thrombectomy (2). The single aortic thrombus was managed by aortic resection and replacement. Pathological evaluation revealed bland thrombi in 31 cases, necrosis in 23, teratoma in 28, active germ cell cancer in 12 and sarcoma in 4. In 40 patients a total of 71 additional procedures were required, including nephrectomy in 32, liver resection in 6, bowel resection in 7, thoracotomy in 6, vertebral resection in 3, orchiectomy in 11, and duodenal repair, ureteroureterotomy, stent removal, cholecystectomy, appendectomy and paraspinal tumor removal in 1 each. There were 17 Clavien III or worse complications in a total of 11 patients, including 2 deaths. Average estimated blood loss was 1,165 ml (range 200 to 7,000) and average hospital stay was 9.3 days (range 2 to 70). Conclusions: The incidence of intraluminal thrombus at post-chemotherapy retroperitoneal lymph node dissection is 5.8%. Cancer pathology was observed in 44.9% of cases. Surgeons who perform post-chemotherapy retroperitoneal lymph node dissection should be well versed in vascular techniques with respect to the major vasculature.

AB - Purpose: We determined the incidence, histology and management of intraluminal thrombus in a large group of patients treated with post-chemotherapy retroperitoneal lymph node dissection. Materials and Methods: We queried the testicular cancer database at our institution from January 1990 to June 2010. Tumor resection en bloc with major vascular structures and/or thrombectomy at post-chemotherapy retroperitoneal lymph node dissection was done in 240 patients, of whom 89 had a total of 98 intraluminal thrombi involving major vasculature. Results: The site of the 98 thrombi was the inferior vena cava (72), aorta (1) and renal vein (20). Management of the 72 vena caval thrombi included cavectomy (36), partial cavectomy (9) and thrombectomy (27). For the 20 renal vein thrombi management included nephrectomy (18) and thrombectomy (2). The single aortic thrombus was managed by aortic resection and replacement. Pathological evaluation revealed bland thrombi in 31 cases, necrosis in 23, teratoma in 28, active germ cell cancer in 12 and sarcoma in 4. In 40 patients a total of 71 additional procedures were required, including nephrectomy in 32, liver resection in 6, bowel resection in 7, thoracotomy in 6, vertebral resection in 3, orchiectomy in 11, and duodenal repair, ureteroureterotomy, stent removal, cholecystectomy, appendectomy and paraspinal tumor removal in 1 each. There were 17 Clavien III or worse complications in a total of 11 patients, including 2 deaths. Average estimated blood loss was 1,165 ml (range 200 to 7,000) and average hospital stay was 9.3 days (range 2 to 70). Conclusions: The incidence of intraluminal thrombus at post-chemotherapy retroperitoneal lymph node dissection is 5.8%. Cancer pathology was observed in 44.9% of cases. Surgeons who perform post-chemotherapy retroperitoneal lymph node dissection should be well versed in vascular techniques with respect to the major vasculature.

KW - blood supply

KW - lymph node excision

KW - testicular neoplasms

KW - testis

KW - thrombosis

UR - http://www.scopus.com/inward/record.url?scp=84881479355&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84881479355&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2013.03.039

DO - 10.1016/j.juro.2013.03.039

M3 - Article

C2 - 23517745

AN - SCOPUS:84881479355

VL - 190

SP - 874

EP - 877

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 3

ER -