Renal cell carcinoma with caval involvement: Contemporary strategies of surgical treatment

Manassero, Francesca; Mogorovich, Andrea; Paola, Giuseppe Di; Valent, Francesca; Perrone, Vittorio; Signori, S; Boggi, Ugo; Selli, Cesare

doi:10.1016/j.urolonc.2009.09.018

Cited by 26 publications

(24 citation statements)

References 19 publications

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“…This result could have been due to the relatively small size of the group with IVC extension. Furthermore, the presence of invasion of IVC wall, not the level of tumor thrombus, was found to be a significant prognostic factor of survival in several studies (26)(27)(28). Thus, invasion of IVC wall by tumor thrombus rather than thrombus level may predict a poor prognosis.…”

Section: Discussionmentioning

confidence: 96%

Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

et al. 2013

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Purpose: To study the surgical outcomes of radical nephrectomy with thrombectomy and to determine prognostic factors for survival of Korean patients with renal cell carcinoma (RCC) and venous tumor thrombus. Materials and Methods: A total of 124 patients with RCC and venous tumor thrombus who underwent radical nephrectomy and thrombectomy were included in this retrospective study. Cancer-specific survival (CSS) and recurrence-free survival (RFS) rates were analyzed retrospectively according to various prognostic factors. Results: The median overall follow-up period for all patients was 29.0 months; the median survival period was 50.0 months. The 2-, 5-and 10-year CSS rates for all patients were 64.2%, 47.1% and 31.7%, respectively. Those for 76 patients (pN0/xM0) without metastasis at presentation were 80.9%, 64.5% and 44.9%, respectively. For all patients, lower body mass index (BMI), higher Fuhrman grade, presence of symptoms, perinephric fat invasion, invasion of inferior vena cava (IVC) wall, lymph node (LN) involvement and distant metastasis at presentation were independent predictors for decreased CSS on multivariate analysis, while thrombus level was not. For non-metastatic patients, lower BMI, presence of symptoms and tumor size were independently associated with decreased CSS. In terms of RFS, lower BMI, presence of perinephric fat invasion were prognostic factors for recurrence. Conclusions: Our data suggest that obesity is independently associated with better survival or lower risk of tumor recurrence in Korean patients undergoing radical nephrectomy with tumor thrombectomy. Also, our results indicate that Fuhrman grade, presence of symptoms, perinephric fat invasion and invasion of IVC wall, LN involvement and distant metastasis at presentation are independent predictors for survival.

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Section: Discussionmentioning

confidence: 96%

Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

et al. 2013

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“…Lambert et al reported that the survival rate decreased with a higher level of tumor thrombus (15). By contrast, other studies proposed that the presence of a tumor thrombus did not reduce the survival rate and increase the risk of further metastasis (5,16,17). IVC invasion and a friable thrombus were reported as independent prognostic factors in two studies (18,19).…”

Section: Discussionmentioning

confidence: 97%

“…To the best of our knowledge, RCC has a biological behavioral tendency for venous system invasion, with extension into the renal vein (50%), IVC (4-10%) or right atrium (~1%) of new cases diagnosed as RCC (5,6). Although local recurrence following radical nephrectomy is another biological behavior, which may recur at numerous locations and occurs in 2-3% of patients (7), the late local recurrence of an RCC thrombus extending from the IVC is rare; a thorough review of the published English literature revealed <10 cases, including the present study (8)(9)(10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

Surgical resection of recurrent inferior vena cava tumor following radical nephrectomy for renal cell carcinoma: A case report

Zhang

Xie

et al. 2015

Oncology Letters

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Abstract. Late recurrence is a known characteristic of the biological behavior of renal cell carcinoma (RCC) following radical nephrectomy. However, the development of recurrent inferior vena cava (IVC) tumors following radical nephrectomy for RCC is a rare event, and surgical resection of recurrent IVC tumors is a challenge for urologists. The present study reports the case of a patient with a local recurrent tumor in the IVC following a right radical nephrectomy 4 years previously for RCC. The patient was referred to the Department of Urology, First Affiliated Hospital of Anhui Medical University, due to bilateral lower extremity edema, and magnetic resonance imaging showed an intraluminal tumor thrombus in the IVC. Therefore, a thrombectomy and partial IVC resection with defect reconstruction were performed successfully. The results of follow-up for 72 months showed that there were no signs of recurrence as local or distant metastasis. This case of local recurrence in the IVC highlights that active long-term surveillance for RCC patients of all stages is important for the early diagnosis of tumor recurrence, which improves the potential resectability.

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“…Incisions vary between surgeons and relate to the extracardiac or intracardiac level of thrombus [22,27,30,31,33]. The debate is akin to that of en bloc or trans hiatal oesophagectomies.…”

Section: Choice Of Incision and The Cardiothoracic Surgeonmentioning

confidence: 99%

Tumour Thrombi in the Suprahepatic Inferior Vena Cava: The Cardiothoracic Surgeons’ View

Protopapas

Ashrafian

Athanasiou

2013

ISRN Vascular Medicine

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Background. Retroperitoneal tumours propagate intrathoracic caval tumour thrombi (ICTT) of which we consider two subgroups: ICTT-III (extracardiac) and ICTT-IV (intracardiac). Methods. Case series review. Results. 29 series with 784 patients, 453 with extracardiac and 331 with intracardiac ICTT. Average age was 59 years. 98% of the tumours were RCC, 1% adrenal and Wilms' tumours, and 1% transitional cell carcinomas. The prevalent incision was rooftop with or without sternotomy. Mortality was 10% (5% for ICTT-III, 15% for ICTT-IV). Morbidity was 56% (36% for ICTT-III, 64% for ICTT-IV) and reoperation for bleeding was the commonest complication (14%). Mean Blood loss was 2.6 litres for ICTT-III and 3.7 litres for ICTT-IV. Mean blood product use was 2.4 litres for ICTT-III and 3.5 litres for ICTT-IV. Operative and anaesthetic times exceeded 5 hours. Hospital stay averaged 13 days. Variations in perioperative care included preoperative embolisation, perioperative transoesophageal echo, surgical incisions, and extracorporeal circulation. Brief Summary. Surgery for ICTT has high transfusion, operating/anaesthetic time, and in-hospital stay requirements, and intracardiac ICTT also attract higher risk. Preoperative tumour embolisation is controversial. The cardiothoracic team offers proactive optimisation of blood loss and preemptive management of intracardiac thrombus impaction: we should always be involved in the management the ICTT.

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Renal cell carcinoma with caval involvement: Contemporary strategies of surgical treatment

Cited by 26 publications

References 19 publications

Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

Surgical resection of recurrent inferior vena cava tumor following radical nephrectomy for renal cell carcinoma: A case report

Tumour Thrombi in the Suprahepatic Inferior Vena Cava: The Cardiothoracic Surgeons’ View

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