PD35-06 VENA CAVOSCOPY IN THE ASSESSMENT OF INTRALUMINAL VENA CAVAL TUMOR INVOLVEMENT

Objective To improve confirmation of complete tumor thrombus removal in advanced malignancy, we report on our experience using intraoperative vena cavoscopy using a flexible cystoscope to confirm complete thrombus resection. Patients with renal cell carcinoma (RCC) or testicular cancer (TC) associated with inferior vena caval tumor involvement benefit from surgical resection of the primary tumor and tumor thrombus. Intraoperative assessment of the vena cava represents a technical challenge, particularly when the thrombus is friable, involves the hepatic veins, or there is caudal extension of thrombus towards the bifurcation. Material and Methods From 2006 to 2014, 36 patients underwent tumor thrombectomy and vena cavoscopy. When residual caval thrombus was suspected, a flexible cystoscope was inserted into the vena cava for direct visual inspection of the caval lumen. Perioperative outcomes including residual tumor, changes in management, and post-operative complications were analyzed. Results All patients underwent endoscopy of the caval lumen without complications. 8 of 36 (22%) patients were found to have residual tumor thrombus visualized during cavoscopy. 5 of these patients had evidence of residual mass and caval invasion within the caval lumen that ultimately resulted in cavectomy. Two patients had residual tumor thrombus that was bluntly removed. One patient was found to have significant involvement of the hepatic veins. Conclusions Vena cavoscopy using a flexible cystoscope is a practical technique that may be utilized intra-operatively in order to ensure clearance of residual thrombus burden within the inferior vena cava and to assess for caval invasion.