Renal cell carcinoma extending into the vena cava: surgical approach, technique and results

Reissigl, Andreas; Janetschek, G.; Eberle, Joe; Colleselli, K.; Weimann, S; Schwanninger, J.; Bartsch, G.

doi:10.1111/j.1464-410x.1995.tb07300.x

Cited by 23 publications

(15 citation statements)

References 17 publications

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“…The prognostic implication of the level of tumour thrombus has been extensively analysed; most series show no significant difference in survival based on the extent of tumour thrombus. However, some have found that tumour thrombus extending to the atrium affects survival more adversely than subdiaphragmatic tumour thrombus [1–10,25]. In previous investigations the 5‐year survival rate for patients with venous involvement and no evidence of metastases at surgery was 30–72%, but in those with metastases at surgery it was 0–25%[1–10,25–27].…”

Section: Discussionmentioning

confidence: 99%

The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus

Blute¹,

Leibovich²,

Lohse³

et al. 2004

BJU International

553

458

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OBJECTIVETo report the surgical management, complications and outcomes over three decades by tumour thrombus level for patients with renal cell carcinoma (RCC) and renal venous extension, as surgery is the most effective treatment. PATIENTS AND METHODSWe assessed 540 patients who underwent surgical resection for RCC with renal venous extension between 1970 and 2000. Early and late surgical complications, including operative mortality, were compared with tumour thrombus level using the chi-square, Fisher's exact and Wilcoxon rank-sum tests. Cancer-specific survival was estimated using the Kaplan-Meier method and compared across tumour thrombus levels using log-rank tests. RESULTSThere were 349 (64.6%) patients with level 0 thrombus and 191 (35.4%) with inferior vena cava thrombus, including 66 (12.2%) with level I, 77 (14.3%) with level II, 28 (5.2%) with level III, and 20 (3.7%) with level IV thrombus. Patients with a higher thrombus level had more early surgical complications (respectively for level 0 to IV, 8.6%, 15.2%, 14.1%, 17.9% and 30.0%, P < 0.001). However, there was no statistically significant difference in the incidence of late complications by thrombus level ( P = 0.445). The incidence of any early surgical complication decreased from 13.4% for patients treated in 1970-1989 to 8.1% for those treated in 1990-2000 ( P = 0.064); the respective operative mortality decreased from 3.8% to 2.0% ( P = 0.260), and in patients with inferior vena cava thrombus, from 8.1% to 3.8% ( P = 0.227). The respective duration of hospitalization decreased from a median of 8 to 7 days ( P < 0.001) but the incidence of late complications increased significantly over time ( P < 0.001.) Among patients with clear cell RCC, the respective estimated 5-year cancer-specific survival rates ( SE , number still at risk) for patients with level 0 to IV thrombus were 49.1 (3.0)% (125), 31.7 (6.4)% (14), 26.3 (6.1)% (11), 39.4 (10.7)% (7) and 37.0 (12.9)% (5), ( P = 0.028). There was a statistically significant difference in outcome for patients with level 0 vs those with level > 0 thrombus ( P = 0.002), but there was no significant difference in outcome by thrombus level among patients with inferior vena cava tumour thrombus ( P = 0.868).The Mayo clinic experience with renal carcinoma and venous tumour thrombus is presented in this section. The authors show that the surgical management of these patients continues to develop, and that complications and mortality are decreasing. They also show that cancer-specific survival is better with renal vein involvement only, as compared with vena caval involvement.

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Section: Discussionmentioning

confidence: 99%

The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus

Blute¹,

Leibovich²,

Lohse³

et al. 2004

BJU International

553

458

View full text Add to dashboard Cite

show abstract

“…Many patients exhibiting IVC invasion require vascular exclusion of the IVC to enable a combined resection. If the excluded IVC on the cranial side is the suprahepatic vena cava, arrangements for extracorporeal circulation are generally required, in addition to total hepatic vascular exclusion ,39. Furthermore, the type of IVC reconstruction (simple closure, path repair, or prosthetic graft replacement) varies according to the extent of caval resection.…”

Section: Discussionmentioning

confidence: 99%

Extent of pathologic invasion of the inferior vena cava in resected liver cancer compared with possible caval invasion diagnosed by preoperative images

Mizutani

Okano

Mori

et al. 2000

Journal of Hepato-Biliary-Pancreatic Surgery

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The extent of cancerous invasion of the inferior vena cava (IVC) determined from resected liver cancer was examined pathologically. Ten patients presenting with liver cancer (metastatic liver cancer, five patients; hepatocellular carcinoma, three; and cholangiocellular carcinoma, two) were diagnosed with positive IVC invasion using preoperative imaging techniques of extracorporeal ultrasonography, computed tomography, magnetic resonance imaging, and vena cavography. The diagnostic criterion for positive IVC invasion by preoperative imaging was longitudinal IVC compression measuring over 50 mm, or transverse IVC compression extending to more than half the circumference of the IVC, or the presence of lesions protruding into the IVC lumen, or the presence of developed collateral veins. All patients underwent combined resection of the IVC. However, pathology results revealed that four of the ten patients had no cancerous invasion of the IVC, and that the extent of invasion along both the longitudinal and transverse axes of the IVC was much smaller than the compression shown by imaging results. We believe that detailed preoperative assessment, using a more precise imaging technique, as well as further intraoperative examination, is required to predict the full pathological extent of cancerous invasion of the IVC.

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“…In addition, the often associated parasitic vasculature and collaterals that develop as a result of vena caval occlusion increase the technical difficulty of nephrectomy. Nevertheless, previous reports have shown that aggressive surgical resection of these lesions can produce long‐term freedom from disease [2–10].…”

Section: Introductionmentioning

confidence: 99%

Renal cell carcinoma: vena caval involvement

2007

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Renal cell carcinoma extending into the vena cava: surgical approach, technique and results

Cited by 23 publications

References 17 publications

The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus

The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus

Extent of pathologic invasion of the inferior vena cava in resected liver cancer compared with possible caval invasion diagnosed by preoperative images

Renal cell carcinoma: vena caval involvement

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