Analysis of surgical outcomes in 102 patients with renal cell carcinoma with venous tumor thrombus: A retrospective observational single-center study

Abstract

The aim of the study was to assess short-and long-term results following radical nephrectomy with renal vein and inferior vena cava thrombectomy in patients with renal cell cancer with venous thrombus and to investigate impact of various demographical, clinical and histological factors on overall survival (OS). The medical records of 102 adult patients with renal cell cancer with venous thrombus admitted for surgery in Department of General, Vascular and Transplant Surgery from 2012 to 2019 were retrospectively analyzed. The tumor was more frequently located on the right side compared to the left one (55 vs. 47). According to Neves Zincke classification, the levels of venous thrombus were as follows: 1 to 48 (47%), 2 to 47 (46%), 3 to 6 (6%), and 4 to 1 (1%). Postoperative complications were noted in 16 (15.7%) patients. One (3%) patient (Neves Zincke 2) died of intraoperative pulmonary embolism during hospitalization. Clear cell carcinoma was the most common pathological type reported in 92 (90.2%) patients. Thirty nine (38.2%) patients were alive at the time of last follow-up. The median OS was 21.50 (0-101.17) months. The 1-year OS was 75.5%. Significantly better OS (median 38.03 months) was noted in patients with RCC Neves Zincke 1 compared to OS (median 14.79 months) in patients with Neves Zincke 2-4 VT (P = .008). Higher tumor staging (T3 vs. T4) (P = .038), nodal staging (N0 vs. N1) (P = .0008), Fuhrman histological grading (G1-2 vs. G3-4) (P = .033) were associated with a shorter OS. Patients with renal cell cancer with venous thrombus, with an acceptable perioperative risk, should be treated surgically, because radical nephrectomy with thrombectomy performed in a high volume surgical center is a safe procedure. Neves Zincke 2-4 venous thrombus, higher tumor and nodal staging, as well higher Fuhrman histological grading are associated with a shorter OS.Abbreviations: CT = computed tomography, DFS = disease-free survival, IVC = inferior vena cava, OS = overall survival, RCC = renal cell carcinoma, RCC-IVCTT = renal cell carcinoma with inferior vena cava tumor thrombus, RCC-VT = renal cell carcinoma with venous thrombus, RV = renal vein, VTT = venous tumor thrombus.

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

“…[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. 17,18 However, Rodriguez Faba et al 19 found that 21% of patients with RCC and tumor venous extension had microscopic vena cava wall invasion in their study. Our clinicopathologic study revealed that 45% of our patients with vena cava tumor thrombi had definitive evidence of vena cava wall microinvasion, which is higher than previously reported in a study done at our institution that reviewed patients from 2006 to 2014.…”

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

“…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).…”