Surgical outcomes for older patients with renal cell carcinoma and inferior vena cava thrombus

Ishiyama, Yudai; Kondo, Tsunenori; Tachibana, Hidekazu; Ishihara, Hiroki; Yoshida, Kazuhiko; Takagi, Toshio; Iizuka, Junpei; Tanabe, Kazunari

doi:10.1016/j.urolonc.2021.12.013

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Historically, patients with RCC and an untreated venous tumor thrombus have always had poor outcomes, especially when it comes to the risk of developing distal embolism and other sequelae related to venous congestion, necessitating the expedition of clinical management; from diagnostic imaging, preoperative evaluation, and surgical extirpation. 11,12 Moreover, the long-standing vena cava obstruction and neoplastic angiogenesis may lead to the development of collateralized vessels and arterialized thrombi which may hinder surgical intervention from a technical standpoint, despite the emergence of advanced robotic-assisted laparoscopic techniques and improved open conventional surgeries. [13][14][15][16] The true estimate of patients with RCC and vena cava involvement with simultaneous vena cava wall invasion is unknown, with the majority of the studies being primarily clinical.…”

Section: Discussionmentioning

confidence: 99%

A Contemporary Clinicopathologic Analysis of Patients With Renal Cell Carcinoma and Vena Cava Involvement

et al. 2023

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Renal cell carcinoma (RCC) is occasionally associated with vena cava involvement. Despite recent advances in therapeutic modalities, the 5-year survival in this population continues to be poor. Therefore, further studies are required to better characterize this patient population, especially from the clinicopathologic standpoint. A comprehensive review of patients with RCC and vena cava involvement managed at our institution from 2014 to 2022 was performed. Multiple clinicopathologic parameters including follow-up were obtained. A total of 114 patients were identified. The mean patient age was 63 years (range: 30-84 years). The cohort consisted of 78/114 (68%) males and 36/114 (32%) females. The mean primary tumor size (excluding tumor thrombus) was 11 cm. The majority of tumors (104/114, 91%) were unifocal. Tumor stages were categorized as follows: pT3b (51/114, 44%), pT3c (52/114, 46%), and pT4 (11/114, 10%). Most of the tumors were clear cell RCC 89/114 (78%), although other more aggressive RCC subtypes were also present. Most tumors were WHO/ISUP grade 3 (44/114, 39%) or 4 (67/114, 59%) with sarcomatoid differentiation present in 39/67 (58%). Necrosis was present in 94/114 (82%) tumors. Twenty-three of 114 (20%) tumors were categorized as pM1 and the ipsilateral adrenal gland was the most common site of metastasis. Of the 91 patients categorized as pM, not applicable at nephrectomy, 42/91 (46%) subsequently developed metastasis, most frequently to the lung. Of all patients, only 16/114 (14%) had positive vascular margins and 7/114 (6%) had positive soft tissue margins despite having very advanced disease and a subset considered inoperable at other centers.

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Section: Discussionmentioning

confidence: 99%

A Contemporary Clinicopathologic Analysis of Patients With Renal Cell Carcinoma and Vena Cava Involvement

et al. 2023

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“…Although many of previous studies acknowledged similar conclusions [43,44], however, the con icting evidence indicated that preoperative sCr in postoperative AKI patients was not signi cantly different from that in non-AKI patients [26], so more authoritative researches should be conducted. According to clinical experience, there should be more relevant factors like race [45], old age [20], laterality[18], high-volume medical centers[46] and so on. Therefore, more researches should be developed to explore those possible risk factors of postoperative renal insu ciency.…”

Section: Other Factorsmentioning

confidence: 99%

“…Among the eligible publications selected for this systematic review, when considered as a binomial variable, the postoperative renal insu ciency was present at least from 0.7% to 53.9% [18][19][20][21][22][23][24][25][26][27][28]. Additionally, in seven cohorts, postoperative AKI was present in a maximum of 53.9% of patients as reported by the study from Shin et al[26] (Table 4).…”

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confidence: 99%

Risk factors for renal insufficiency after radical nephrectomy and thrombectomy in renal cell carcinoma with tumor thrombus: A systematic review

Huang,

Liu,

Zhuo

et al. 2024

Preprint

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Background: Renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is great burden over world. Radical nephrectomy (RN) with thrombectomy seems to be its gold standard operation, which might cause reduction of renal function. The aim of this systematic review was to provide evidence about the incidence, risk factors, possible reasons and influence of renal insufficiency in RCC patients undergoing RN with thrombectomy. Methods: A systematic search using PubMed, Embase, Web of Science, the Cochrane Library and European Urology databases was conducted. Study selection followed the PRISMA guidelines. After screening, eleven articles and abstracted fully compatible with the PICOS were included in this systematic review. The study was registered with PROSPERO, CRD42024516596. Results: Overall, a total of 1,668 patients who were diagnosed with RCC and VTT and underwent RN (open/laparoscopic/robotic) with thrombectomy were analyzed. The postoperative renal insufficiency was presen from 0.7% to 53.9%. Relevant risk factors of postoperative renal insufficiency could be summarized into three aspects: baseline characteristics (male gender, tumor thrombus level), intraoperative procedure (surgical method and inferior vena cava clamping time) and other factors (development of the times). The reason of renal insufficiency could be depletion of circulation volume, alteration in renal hemodynamics and condition of solitary kidney. Necessary managements like supplying blood volume, diuretic therapy and renal replacement therapy should be applied. Conclusions: The present incidence of postoperative renal insufficiency was underestimated. More possible risk factors should be explored. Large cohort, multi-center, prospective, and well-designed studies would be necessary to corroborate these results and provided with high-grade recommendation for clinical practice.

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French AFU Cancer Committee Guidelines - Update 2022-2024: management of kidney cancer

Bigot

Barthélémy

Boissier

et al. 2022

Progrès en Urologie

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Surgical outcomes for older patients with renal cell carcinoma and inferior vena cava thrombus

Cited by 3 publications

References 18 publications

A Contemporary Clinicopathologic Analysis of Patients With Renal Cell Carcinoma and Vena Cava Involvement

A Contemporary Clinicopathologic Analysis of Patients With Renal Cell Carcinoma and Vena Cava Involvement

Risk factors for renal insufficiency after radical nephrectomy and thrombectomy in renal cell carcinoma with tumor thrombus: A systematic review

French AFU Cancer Committee Guidelines - Update 2022-2024: management of kidney cancer

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