The value of a cross‐discipline team‐based approach for resection of renal cell carcinoma with IVC tumor thrombus: A report of a large, contemporary, single‐institution experience

Abstract

Introduction We report the evolution of the largest, contemporary, single‐institution experience with this complex procedure to highlight the value of a cross‐discipline, team‐based approach. Methods Patients from a prospectively maintained database who underwent resection of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus from 2005 to 2016 at a single‐institution were included for analysis. Results Of 140 patients, 102 (73%) had tumor thrombus below the level of the hepatic vein confluence, and 96 (69%) were performed for curative‐intent, while 43 (31%) were cytoreductive procedures for clinical trial consideration. Median overall survival (OS) of the entire cohort was 43.8 months (5‐year OS:43%), and 73.6 months (5‐year OS:59%) for those without metastatic disease. Fifty‐one patients underwent resection from 2005 to 2010 and 89 from 2011 to 2016. All procedures since 2011 were performed by the same cross‐discipline dedicated team of two surgeons, composed of a surgical and urological oncologist. When comparing the two time‐periods, the team‐approach after 2011 had shorter operative‐times (5.3 vs 6.7 hours; P = 0.009), decreased ICU‐utilization (25% vs 72%; P < 0.001), and decreased ICU length‐of‐stay (0.4 vs 2.2 days; P = 0.001). This group also trended towards less blood loss (1.2 vs 1.8 L), shorter average hospital length‐of‐stay (10 vs 11 days), and decreased 90‐day mortality (6% vs 10%). Conclusion Resection of RCC with IVC tumor thrombus yields long‐term survival. A dedicated, cross‐discipline, and team‐based approach optimizes patient outcomes and may improve value of care by reducing utilization of expensive hospital resources.

Outcomes of Renal Cell Carcinoma with Associated Venous Tumor Thrombus: Experience from a Large Cohort and Short Time Span in a Single Center

“…After excluding 64 patients who did not meet the inclusion criteria, 121 were available for analysis. Table 1 Prior study suggested that surgery for VTT above the hepatic vein is much more di cult than that of VTT below the hepatic vein [12]. Thus, the VTT above the hepatic veins was de ned as high level, while VTT below the hepatic veins was de ned as low level in this study.…”

“…Even for experienced urologist, perioperative complications cannot be avoided completely. However, popularization of the multidisciplinary collaboration improves the safety of the patients with RCC with VTT, and decreases mortality [12]. In our cohort, a multidisciplinary team, consisting of an urologist, anesthesiologist, cardiac surgeon, general surgeon, critical care physician and radiologist, offered comprehensive and systematic perioperative plan and management for the patients received RNTE.…”

“…Although surgical techniques and perioperative management have been improved a lot over time, the overall survival of patients with RCC and VTT remains poor, with 5-year OS varied from 37-71% [8,[12][13][14][15][16]. This wide variation may result from varied sample size, VTT level, surgical era, tumor pathological classi cation, comorbidities of patient population and improvements in adjuvant therapy.…”

Extracorporeal Partial Nephrectomy with Orthotopic Autotransplantation under Pharmaco-Cold Ischaemia for Cancer of a Single Kidney: A Case Report

“…Median OS of the entire cohort was 43.8 months (5-year OS: 43%), and 73.6 months (5-year OS: 59%) for those without metastatic disease. RRT was required in 2 (1%) cases [ 16 ].…”

“…In some cases, when “in situ” renal resection is not possible (multiple, large, or centrally located tumours), authors resorted to performing ECPN with ortho- or heterotopic autotransplantation of the resected kidney [ 12 , 17 ]. Currently, the experience with such operations is not great, but their results are satisfactory [ 12 , 14 , 16 , 17 , 18 , 19 ]. Anyhow, we could not find cases of ECPN with orthotopic replantation under pharmaco-cold ischaemia for RCC complicated by IVC tumour thrombosis in single kidney in the literature.…”