Outcomes of left renal vein reconstruction after resection of tumors involving the infrarenal inferior vena cava.

Abstract

There is still debate about whether ligation or reconstruction is optimal for the management of the left renal vein during resection of tumors involving the infrarenal inferior vena cava. We assessed factors associated with thrombosis of left renal vein reconstruction. We retrospectively reviewed consecutive resections of the infrarenal inferior vena cava between 2010 and 2024. Of 20 included patients, simultaneous right nephrectomy was performed in 19 patients. Segmental inferior vena cava resection was performed for 19 patients (1 lateral resection). In all cases, a ringed polytetrafluoroethylene prothesis was used for inferior vena cava reconstruction. The left renal vein was reconstructed in 14 cases. Reconstruction included interposition of a polytetrafluoroethylene prosthesis between the left renal vein and the inferior vena cava prothesis (n = 6), direct reimplantation of the left renal vein on the inferior vena cava prosthesis (n = 5), and transposition of the left renal vein on the native inferior vena cava below the natural confluence (n = 3). During the first 90 days postoperatively, thrombosis of the reconstructed left renal vein occurred in 7 patients (50%) (4 after direct reimplantation and 3 after interposition of a polytetrafluoroethylene prothesis). The rate of left renal vein reconstruction thrombosis was significantly higher in cases of preoperative stenosis of the confluence of the left renal vein into the inferior vena cava (5/7; P = .02) and cases of collateral left genital or lumbar veins with diameter ≥10 mm (7/7; P < .0001). The rate of acute renal failure did not differ between reconstructed and ligated left renal vein (2 vs 1; P = .467). Left renal vein reconstruction thrombosis was not associated with chronic renal failure in long-term follow-up. During resection of the infrarenal inferior vena cava with simultaneous right nephrectomy, large lumbar or genital veins (≥10 mm) seen in preoperative imaging may obviate the need for left renal vein reconstruction. Because of the small size of this study, this finding needs to be confirmed prospectively in larger series.