Clinical management of renal cell carcinoma with venous tumor thrombus

Agochukwu, Nnenaya; Shuch, Brian

doi:10.1007/s00345-014-1276-7

Cited by 42 publications

(41 citation statements)

References 34 publications

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“…3e9 The surgical management of RCC with advanced tumor thrombus extension is technically challenging and often requires a multidisciplinary surgical approach. 10 However, surgery in patients with venous tumor invasion remains associated with a considerable risk of morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of perioperative complications in open and laparoscopic surgery for renal cell cancer with tumor thrombus involvement using the Clavien–Dindo classification

Ebbing

Wiebach

Kempkensteffen

et al. 2015

European Journal of Surgical Oncology (EJSO)

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Section: Introductionmentioning

confidence: 99%

Evaluation of perioperative complications in open and laparoscopic surgery for renal cell cancer with tumor thrombus involvement using the Clavien–Dindo classification

Ebbing

Wiebach

Kempkensteffen

et al. 2015

European Journal of Surgical Oncology (EJSO)

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“…Renal cell carcinoma (RCC) is the third most common genitourinary malignancy, accounted 65000 new cases and caused 13600 death each year in the US 1 . Approximately 10% of the cases presented with tumor and/or thrombus involvement of the renal vein and vena cava.…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 10% of the cases presented with tumor and/or thrombus involvement of the renal vein and vena cava. 1% of the patients with RCC presented with tumor thrombus above the level of the hepatic vein (Level 3 and 4) 1 . Without treatment, patients with caval thrombus have high mortality risk 2 .…”

Section: Introductionmentioning

confidence: 99%

“…These cases will often require the use of cardiopulmonary bypass (CPB) with/without hypothermia circulatory arrest. Previous studies have reported on the success of performing level III/IV thrombectomy without the use of cardiopulmonary bypass, given the associated morbidity when placing patients on CPB 1 . Most surgeons advocate for the use of CPB in complex cases involving tumor thrombus extending into the right atrium 5 .…”

Section: Introductionmentioning

confidence: 99%

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Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy: Multi-Institutional Analysis

et al. 2015

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Purpose The impact of cardiopulmonary bypass (CPB) usage in level III-IV tumor thrombectomy on surgical and oncologic outcomes is unknown. We sought to determine the impact of cardiopulmonary bypass (CPB) on overall and cancer specific survival, as well as surgical complication rates, and immediate outcomes in patients undergoing nephrectomy and level III-IV tumor thrombectomy with or without CPB. Patients and Methods We retrospectively analyzed 362 patients with RCC and with level III or IV tumor thrombus from 1992 to 2012 in 22 US and European centers. Cox proportional hazards models were used to compare overall and cancer-specific survival between patients with and without CPB. Perioperative mortality and complications rates were assessed using logistic regression analyses. Results The median overall survival was 24.6 months in non-CPB patients and 26.6 months in CPB patients. Overall survival and cancer-specific survival (CSS) did not differ significantly in both groups, neither in univariate analysis nor when adjusting for known risk factors. In multivariate analysis, no significant differences were seen in hospital LOS, Clavien 1-4 complication rate, intraoperative or 30 day mortality, and CSS between both groups. Limitations include the retrospective nature of the study. Conclusions In our multi-institutional analysis, the use of cardiopulmonary bypass did not significantly impact cancer specific survival or overall survival in patients undergoing nephrectomy and level III or IV tumor thrombectomy. Neither approach was independently associated with increased mortality in the multivariate analysis. Higher surgical complications were not independently associated with the use of CPB.

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“…Furthermore, there is a palliative profit in the surgical approach, particularly if the patient has local symptoms as abdominal pain or dyspnoea. In the setting of metastatic disease, systemic therapy is also being used as adjuvancy, potentially providing longer survival rates and subsequently expanding the indications for surgery, including aggressive surgeries like nephrectomy and thrombectomy [5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Renal Cell Carcinoma with Venous Thrombus: Should Surgery Be Offered When Metastasis Is Present at Diagnosis?

et al. 2018

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Introduction: Renal cell carcinoma (RCC) reveals a tendency towards venous invasion in its advanced stages, making clinical management challenging. Survival may be improved following surgery, but is less clear if it applies to patients with metastatic disease at diagnosis. Materials and Methods: Review of clinical files of patients submitted to surgery for RCC at our institution. Results: Twenty-one patients underwent radical nephrectomy and thrombectomy from 2000 to 2017, with a median follow-up of 25 months. Eighteen (85.7%) men and 3 (14.3%) women, with median age of 63 at the time of diagnosis, were included. The thrombus was in the renal vein in 10 (47.6%) patients and had extension to inferior vena cava (IVC) in 11 (52.4%). The level of involvement in IVC was grade II in 4 (19%) cases, grade III in 4 (19%) cases and grade IV in 3 (14.4%) cases. Surgery was successful in all but 1 patient. Ten patients died during the follow-up (47.6%), resulting in a 5-year overall survival of 34.8%. When considering the metastatic population at diagnosis, the overall survival at 5 years was 45.7%. Conclusion: Radical nephrectomy with removal of the venous thrombus remains the preferential treatment for patients with RCC with venous thrombus, even if they have metastatic disease at diagnosis.

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Clinical management of renal cell carcinoma with venous tumor thrombus

Cited by 42 publications

References 34 publications

Evaluation of perioperative complications in open and laparoscopic surgery for renal cell cancer with tumor thrombus involvement using the Clavien–Dindo classification

Evaluation of perioperative complications in open and laparoscopic surgery for renal cell cancer with tumor thrombus involvement using the Clavien–Dindo classification

Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy: Multi-Institutional Analysis

Renal Cell Carcinoma with Venous Thrombus: Should Surgery Be Offered When Metastasis Is Present at Diagnosis?

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