Multidetector computed tomography vs magnetic resonance imaging for defining the upper limit of tumour thrombus in renal cell carcinoma: a study and review

Lawrentschuk, Nathan; Gani, Johan; Riordan, Richard; Esler, Steven; Bolton, Damien

doi:10.1111/j.1464-410x.2005.05617.x

Cited by 104 publications

(55 citation statements)

References 35 publications

(72 reference statements)

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“…Recently published study by Lawrentschuk et al also showed the complete accuracy of MDCT in detection of the upper extent of the tumor thrombus compared with surgical report. In that study, MDCT was accurate in all the eight cases [43].…”

Section: Discussionmentioning

confidence: 95%

Venous spread of renal cell carcinoma: MDCT

et al. 2006

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Section: Discussionmentioning

confidence: 95%

Venous spread of renal cell carcinoma: MDCT

et al. 2006

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“…Para ello puede ser útil la utilización de la ecografía-doppler, ecografía transesofágica o la resonancia nuclear magnética con gadolinio 24 , siendo útil el TAC para el diagnós-tico inicial; de entre estas pruebas diagnósticas se ha considerado la RNM como la más sensible y específica para la valoración de la presencia y extensión del trombo en los vasos representando el gold standard 26 . La extensión craneal del tumor fue definida por Neves y Zincke 27 ; se pueden establecer cuatro niveles: nivel I, renal; nivel II, infrahepático; nivel III, retrohepático; nivel IV, atrial.…”

Section: Discussionunclassified

Carcinoma de células renales con extensión a vena cava: puesta al día y revisión de nuestra casuística

Alonso

Prados

Olmo³

et al. 2009

Actas Urol Esp

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E l carcinoma de células renales representa el 2% de todos los cánceres del adulto 1 . Una de las características que presenta el carcinoma renal es su venotropismo; de hecho se estima que en el momento del diagnóstico es posible encontrar trombo tumoral en la vena renal en el 20-35% de los casos, y extensión a la vena cava inferior (VCI) en el 4-10%, pudiendo extenderse el trombo por encima de las venas suprahepáticas hasta alcanzar la aurí-cula derecha 2-4 . Cuando ocurre, la cirugía ofrece la única solución curativa 5 , siendo en estos casos compleja y requiriendo un amplio conocimiento de la anatomía y la participación de un equipo multidisciplinar. La vía de abordaje así como la técnica quirúrgica dependen del nivel que alcance el extremo cefálico del trombo tumoral en la vena cava. ResumenObjetivo: Valorar la situación actual en el tratamiento del carcinoma renal con extensión a vena cava inferior (VCI): Clasificación, diagnóstico, abordaje quirúrgico, terapia adyuvante, factores de pronóstico y supervivencia. Materiales y Métodos: Se revisan 19 casos de carcinomas renales con extensión a VCI intervenidos entre enero de 1988 y agosto de 2008. Se valoran la edad, el sexo, lateralidad y función renal de los pacientes. Con respecto al tumor se valoran: estadio según TNM y la clasificación de Neves-Zincke. Se describe el abordaje quirúrgico según el nivel del trombo. Resultados: Con una tasa de mortalidad perioperatoria del 10.5% y una media de seguimiento de 22,65 meses (rango 2-79), sobreviven 5 pacientes; 11 han fallecido por la enfermedad; uno por otra causa y 2 se han perdido. Los pacientes metastásicos han recibido tratamiento adyuvante con Inmunoterapia o inhibidores de las kinasas. La supervivencia media es de 15,1 meses. Existen diferencias significativas a tres y cinco años en la supervivencia de los pacientes estadiados como N0M0 vs resto (N+M0, N0M+, N+M+). No hay diferencias en función del nivel del trombo. Conclusiones: El carcinoma renal con trombo en VCI es un tumor con alta mortalidad. El abordaje quirúrgico del mismo es la opción más valida y precisa una correcta valoración prequirúrgica y el apoyo de un equipo multidisciplinar preparado y con experiencia. La supervivencia depende de la extensión de la enfermedad. Renal cell carcinoma with vena cava involvement: update and review of our series AbstractObjective: To assess current management of renal cell carcinoma (RCC) extending into the inferior vena cava (IVC): staging, diagnosis, surgical approach, adjuvant therapy, prognostic factors and survival rate. Materials and Methods: Nineteen cases of RCC extending into the IVC undergoing surgical resection from January 1988 to August 2008 were reviewed. TNM staging and Neves-Zincke grading of the tumor were also assessed. Surgical approach depended on thrombus level. Results: With a perioperative mortality rate of 10.5% and a mean follow-up of 22.65 months (range 2-79), 5 patients are still alive, while 11 patients died from the disease, 1 from an unrelated cause, and 2 were lost to follow-up....

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“…Identifying the extent of IVC involvement is crucial for staging & planning. Although the extent of IVC thrombus can be identified by abdominal sonography & computed tomography, the sensitivity of MRI is superior to these techniques (96-100%) & is now the gold standard for assessing the level of thrombus [21,22]. Currently MRIscan is the Gold Standard for delineating the level & extent of tumor thrombi in the IVC & staging of RCC with a Sensitivity of 96-100%.…”

Section: Level Of Thrombusmentioning

confidence: 99%

“…Currently MRIscan is the Gold Standard for delineating the level & extent of tumor thrombi in the IVC & staging of RCC with a Sensitivity of 96-100%. It may even rule out caval wall invasion so that exact surgical procedure can be planned [21,22]. Infrahepatic thrombi were present in about 58% of patients & retro hepatic & suprahepatic in about 28% & 14% respectively.…”

Section: Level Of Thrombusmentioning

confidence: 99%

IVC Thrombectomy in Renal Cell Carcinoma—Analysis of Out Come Data of 100 Patients and Review of Literature

Kulkarni

Jadhav

Valsangkar

2011

Indian J Surg Oncol

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To review our experience of RCC with IVC thrombus in terms of clinical presentation, principles of surgical management in contemporary era, also an impact of clinico-pathological factors on prognosis. Total 100 patients who underwent radical nephrectomy and IVC thrombectomy between 1991-2008 were included in this retrospective analysis. Data was analysed in terms of clinical pathological factors, survivals and compared with contemporary literature. The extent tumour thrombus was infrahepatic in 58 retro hepatic in 28 and suprahepatic in 14 patients including 6 with right atrial thrombus. The immediate postoperative mortality was 2% and incidence of major postoperative non fatal complications was 38%, which were managed conservatively. The overall and disease free 5 year survival was 63% and 55%. Further amongst the histological types, patients with clear cell tumours had the best (DFS-71.42%), and those with papillary had the poor (DFS-30.76%) outcome. Grade II tumors had better survivals as compared to grade IV (DFS 75.39% vs 23.52%, p<0.05). Loco-regional extent wise 74% patients without perinephric fat invasion were free from disease at 5 years as compared to 30% of those who had perinephric fat invasion (p<0.01). Similarly 5 year DFS was 76.11% in patients with negative nodes as compared to 12% in positive nodes (p<0.01). In conclusion radical nephrectomy with IVC thrombectomy still remains the most effective therapeutic option in management in this clinical setting. Although this is complicated surgery success with multi disciplinary approach excellent survival outcome can be obtained. Further pathological factors, such as locoregional spread and grade of tumor, rather than clinical factors influence long term survival.

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Multidetector computed tomography vs magnetic resonance imaging for defining the upper limit of tumour thrombus in renal cell carcinoma: a study and review

Cited by 104 publications

References 35 publications

Venous spread of renal cell carcinoma: MDCT

Venous spread of renal cell carcinoma: MDCT

Carcinoma de células renales con extensión a vena cava: puesta al día y revisión de nuestra casuística

IVC Thrombectomy in Renal Cell Carcinoma—Analysis of Out Come Data of 100 Patients and Review of Literature

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