Early and long-term patency of inferior vena cava patch reconstruction in children with renal tumour thrombus

Aim Intravascular extension of renal tumours to the inferior vena cava (IVC)/right atrium (RA) represent a major surgical challenge. We report outcomes of IVC patch reconstruction (IVC-PR) following tumour-thrombus resection (TTR) in children. Methods Retrospective review of all patients after TTR IVC-PR (2007-2023): doppler ultrasound assessed IVC patency. Secondary outcomes: 30-day surgical mortality/morbidity, relapse or death. Results Wilms tumour 19/21(90%) and renal Ewings sarcoma 2/21(10%) prompted TTR IVC-PR in 21 patients, aged 2-16years (8/21(38%) metastatic, 1/21(5%) bilateral). Tumour Thrombus (TT) extended to RA 8/21(38%), hepatic veins 9/21(43%) and infra-hepatic IVC 4/21(19%). After neo-adjuvant chemotherapy, TT regressed in 8/21(38%). Noteworthy venous collaterals were present in 18/21(86%). Pre-operatively, 5/21(24%) received anticoagulation, 4/5(80%) with bleeding complications. TTR IVC-PR - on cardio-pulmonary bypass in 17/21(81%) - occurred alongside tumour nephrectomy in 19/21(90%) and as a secondary procedure after disease progression/relapse in 2/21(10%). A macroscopically complete TTR was achieved for all, en-bloc in 17/21(81%). Stage III was assigned to 19/21(90%), with viable TT in 16/21(76%). There was no 30-day mortality. Complications occurred in 10/21(48%), necessitating return to theatre for 4/21. Post-operative anticoagulation for a median 5(2-14)months ensued without bleeding complications. At median 4.5(1-15)years follow-up, IVC-PR was patent in 15/21(71%): the luminal calibre normal in 11/15(73%) and reduced in 4/11(27%) patients. Although asymptomatic, 6/21(29%) had a non-patent IVC-PR. Relapse occurred in 2/21(10%) patients (1 died), both after secondary TTR. Conclusions TTR at radical nephrectomy appears important for survival. IVC-PR was patent in the majority, without clinically significant adverse effects during childhood for those without IVC-PR patency.