Surgery for Renal Cell Carcinoma in the Vena Cava

Marshall, Victor F.; Middleton, Richard G.; Holswade, George R.; Goldsmith, Edward I.

doi:10.1016/s0022-5347(17)61970-0

Cited by 240 publications

(81 citation statements)

References 14 publications

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“…Ever since the first report of radical surgery for RCC with IVC thrombus in 1970 [17], several authors have reported their success and long term survivals. Thus today excision of venacaval thrombus excision has become a standard of care.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Marshall, et al reported that among patients with renal cancer, 33% show tumor spread to the renal vein and 6% exhibit tumor invasion of the inferior vena cava. 10) According to Javidan, et al the survival rate of patients with renal cancer is 95% for cases with stage I cancer, 88% for those with stage II, 59% for those with stage III, and 20% for those with stage IV cancer. 11,12) In our cases, preoperative pulmonary blood flow scintigraphy revealed multiple defects in both lung fields, and CT revealed multiple infarctions in the lungs; no signs of lung metastasis were observed.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Malignant Tumors of the Right Heart.

et al. 2002

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SUMMARYSeven patients with malignant cardiac tumors were treated surgically in the Department of Cardiothoracic Surgery of the University of Tokyo between 1981 and 2000. Their treatments and outcomes are summarized and discussed. The ages of the patients ranged from 21 to 70 years old (mean: 49.5±15) and there were three males and four females. The histopathological diagnoses were hepatocellular carcinoma (HCC), spindle cell sarcoma, round cell sarcoma, osteosarcoma, renal cell carcinoma, and leiomyosarcoma. In four of the cases, the tumor extended or metastasized from other organs, while in the other three cases it originated in the heart. Before the cardiac operation, an above-knee amputation, left nephrectomy, transarterial embolization, or extended right hepatic lobectomy had been performed to treat the primary site of the tumor. Tumor resection using cardiopulmonary bypass was performed in every case. The NYHA classification of heart failure was significantly improved (preop: 3.3±0.8, postop: 1.9±0.7 [P<0.001]). The mean survival period of the patients who died was 8.8±7.0 months. A patient with renal cell carcinoma is still alive after 87 months of follow-up.In summary, surgical treatment of malignant tumors of the right heart can improve the QOL in patients with cardiac failure. However, its effectiveness was temporary in all cases except one case of renal cell carcinoma. (Jpn Heart J 2002; 43: 263-271)

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“…While Marshall et al [1] and Skinner et al [2] reported the successful removal of tumor thrombus extending into the vena cava without an adverse effect on survival, encouraging the surgical treatment of such patients, use of the surgical option is still limited by the high morbidity of vena cava thrombectomy and by the presence of metastatic disease at presentation in a third of these patients [1,[3][4][5]. The presence of lymph node or distant metastasis significantly decreases the prospect of extended survival even if surgical treatment is successful [6].…”

Section: Introductionmentioning

confidence: 99%

“…The inferior vena cava is involved in tumor thrombus in 4-10% of patients with renal cell carcinoma [1], and the value of radical nephrectomy + vena cava thrombectomy for these patients has long been controversial. While Marshall et al [1] and Skinner et al [2] reported the successful removal of tumor thrombus extending into the vena cava without an adverse effect on survival, encouraging the surgical treatment of such patients, use of the surgical option is still limited by the high morbidity of vena cava thrombectomy and by the presence of metastatic disease at presentation in a third of these patients [1,[3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Management of Renal Cell Carcinoma with Inferior Vena cava Tumor Thrombus

Matsui¹,

Fujikawa²,

Oka³

et al. 2001

Urol Int

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Objective: The prognostic implication of radical nephrectomy with inferior vena cava tumor thrombectomy for renal cell carcinoma is still controversial. We investigated the type of renal cell carcinoma with vena cava tumor thrombus for which surgical resection was beneficial. Materials and Methods: We retrospectively reviewed the records of 16 patients with renal cell carcinoma and inferior vena cava tumor thrombus. Of these, 10 received surgical treatment and 6 did not. We evaluated the association between the pretreatment serum C-reactive protein (CRP) level and the efficacy of surgery. Results: Among the 8 patients with an elevated pretreatment serum CRP level (CRP ≧1.0 ng/ml), there was no significant difference of the median disease-specific survival between those who did (20.2 months) and did not undergo surgery (8.2 months; p = 0.1946). On the other hand, among the 8 patients who had a pretreatment serum CRP level within normal limits (CRP < 1.0 ng/ml), the median disease-specific survival of those who did not undergo surgery (80.6 months) was significantly better than that of those who did (50.2 months; p = 0.0136). Conclusion: This study suggested that conservative treatment can be recommended for patients with renal cell carcinoma and inferior vena cava tumor thrombus when the pretreatment serum CRP level is normal because tumor progression is usually slow and surgical treatment may actually worsen the prognosis.

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Surgery for Renal Cell Carcinoma in the Vena Cava

Cited by 240 publications

References 14 publications

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

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

Surgical Treatment of Malignant Tumors of the Right Heart.

Management of Renal Cell Carcinoma with Inferior Vena cava Tumor Thrombus

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