Preoperative Pulmonary Embolism Does Not Predict Poor Postoperative Outcomes in Patients with Renal Cell Carcinoma and Venous Thrombus

Abel, E. Jason; Wood, Christopher G.; Eickstaedt, Nathan L.; Fang, Justin E.; Kenney, Patrick A.; Bagrodia, Aditya; Youssef, Ramy; Sagalowsky, Arthur I.; Margulis, Vitaly

doi:10.1016/j.juro.2013.02.033

Cited by 25 publications

(8 citation statements)

References 28 publications

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“…An interesting aspect of this case is the fact that despite considerable amounts of tumor thrombi remaining in the IVC filter, the IVC itself as well as in the iliac veins, there are still no signs of local or any suspicion for metastatic progression after a follow-up of more than 1 year. This suggests -similar to the effect of cytoreductive nephrectomy on systemic metastases or recurrence rates after pulmonary embolism [7,8] -that the cancer cells within the thrombotic metastases might somehow be dependent on the presence of their primary tumor to proliferate and disseminate. The underlying biological mechanisms of this phenomenon remain elusive.…”

Section: Linxweiler Et Almentioning

confidence: 78%

Organ-Preserving Surgical Treatment of a Horseshoe Kidney Occupied by a Large Renal Cell Carcinoma with Extensive Venous Invasion: A Case Report

Linxweiler

Shayesteh-Kheslat²,

Fries³

et al. 2016

Urol Int

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The horseshoe kidney is one of the most common congenital disorders affecting the urogenital system. Following a fusion of the lower kidney poles, which in turn lead to the formation of an isthmus, this anatomical variation is accompanied by other characteristic properties like an incomplete ascension, ventral rotation of the pelvices as well as atypical vascular supply. Even though renal carcinoids and Wilms tumors are more common in horseshoe kidneys, the incidence of renal cell carcinomas seems to be unaffected. Here we report the case of a locally advanced renal cell carcinoma with extensive venous invasion occurring in a horseshoe kidney and its complex surgical management. The whole primary tumor as well as a majority of venous tumor thrombi could be removed by a combination of 2/3 nephrectomy and cavotomy with thrombectomy. During 1 year of follow-up, the patient neither suffered from a tumor relapse, nor did he require renal replacement therapy. Thus, we conclude that even in cases of RCC where advanced disease is associated with complex anatomical situations, organ-preserving surgical treatment should be pursued to achieve excellent functional and oncological results.

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Section: Linxweiler Et Almentioning

confidence: 78%

Organ-Preserving Surgical Treatment of a Horseshoe Kidney Occupied by a Large Renal Cell Carcinoma with Extensive Venous Invasion: A Case Report

Linxweiler

Shayesteh-Kheslat²,

Fries³

et al. 2016

Urol Int

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“…A recent study in 2013 showed a preoperative pulmonary embolism in 4.4% of renal cell carcinoma patients with proven venous thrombus. 11 Nevertheless, it seems likely that the mechanical obstruction of the vena cava had a significant impact on the development of pulmonary artery embolism.…”

Section: Discussionmentioning

confidence: 99%

A case of pulmonary embolism caused by compression of the vena cava by intra‐abdominal masses in autosomal polycystic kidney disease

Holzmann‐Littig

Lorenz

Wen

et al. 2020

Clinical Case Reports

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Approximately 10% of dialysis patients suffer from autosomal dominant polycystic kidney disease. This disorder leads to several complications including infections, hematuria, and chronic pain. Here, we present a case of a 48-year-old patient with pulmonary artery embolism due to vena cava obstruction by the right polycystic kidney. Although not very common in the general population, autosomal dominant polycystic kidney disease is one of the more common autosomal dominant inherited diseases. The prevalence in dialysis patients is approximately 10% and approximately 1/1000-1/400 live births. 1,2 The underlying mutation is found in the polycystic kidney disease 1 (PKD1) gene in 85% of all cases and in the PKD2 gene in 15% of all cases. 2 Common complications are cyst infections, hematuria, cyst bleeding, nephrolithiasis, and chronic pain. 3 Cerebral aneurysms may cause intracranial bleeding, yet the risk for aneurysm ruptures is usually regarded low. 3 Other organs, particularly the liver, but also blood vessels and the heart can be affected. 3 The increasing kidney volume (due to growing cyst volume) may lead to a compression of intra-abdominal structures; however, a pulmonary embolism caused by this complication has rarely been reported.

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“…Therefore, abdominal abnormalities, such as RCC, are included in the differential diagnosis of PE in addition to lower limb deep vein thrombosis. Abel et al reported that PE was identified preoperatively in 35 of 782 patients (4.4%) with RCC 10) . However, the incidence of PE due to RCC is relatively rare; identification of RCC as the cause is critical for deciding on the additional surgical therapy along with anticoagulant therapy.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of electrocardiographic changes in accurate and urgent diagnosis of pulmonary embolism due to renal cell carcinoma

Kawano

Kato

Kïtamura

2018

Health evaluation and promotion

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Pulmonary embolism (PE) is a clinical entity with a high mortality rate and hence requires accurate, urgent diagnosis and emergency therapy. We report a case of successful treatment of PE in a patient with renal cell carcinoma (RCC) with tumor thrombosis of the renal vein and the inferior vena cava (IVC). PE was diagnosed using electrocardiography (ECG), echocardiography, D-dimer level elevation and contrast-enhanced computed tomography. First, ECG showed a new sinus tachycardia and T wave flattening in the inferior leads (II, III, aVf) in contrast to routine ECG performed previously at a medical health checkup. Second, echocardiography revealed a dilated right ventricle, tricuspid regurgitation, and elevation of systolic pulmonary artery pressure. We emergently inserted a temporary IVC filter at the proximal end of the tumor thrombus under serial echocardiographic evaluation, followed by thrombolytic therapy and anticoagulation therapy. After 3 days, we performed radical nephrectomy and thrombectomy of the IVC. After surgery, the temporary IVC filter was removed, and the anticoagulation therapy was continued. The patient remained symptom free 3 years after surgery. For the diagnosis of PE, it is important to compare the previous ECG obtained on routine medical health checkup and the ECG results at diagnosis. In conclusion, during a medical health checkup in clinical practice, despite its rare occurrence, a life-threatening PE should be ruled out in a patient with risk factors, symptoms, and ECG findings such as tachycardia and ST-T change in the inferior leads and patients with such findings should be urgently referred to a cardiovascular specialist.

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Preoperative Pulmonary Embolism Does Not Predict Poor Postoperative Outcomes in Patients with Renal Cell Carcinoma and Venous Thrombus

Abstract: Preoperative pulmonary embolism is not associated with worse early mortality, recurrence or cancer specific survival in patients with renal cell carcinoma and tumor thrombus.

Cited by 25 publications

References 28 publications

Organ-Preserving Surgical Treatment of a Horseshoe Kidney Occupied by a Large Renal Cell Carcinoma with Extensive Venous Invasion: A Case Report

Organ-Preserving Surgical Treatment of a Horseshoe Kidney Occupied by a Large Renal Cell Carcinoma with Extensive Venous Invasion: A Case Report

A case of pulmonary embolism caused by compression of the vena cava by intra‐abdominal masses in autosomal polycystic kidney disease

Usefulness of electrocardiographic changes in accurate and urgent diagnosis of pulmonary embolism due to renal cell carcinoma

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