Current Trends in Management of Renal Cell Carcinoma with Venous Thrombus Extension

Jurado, Alberto; Romeo, Agustín; Gueglio, Guillermo; Marchiñena, Patricio García

doi:10.1007/s11934-021-01036-y

Cited by 20 publications

(12 citation statements)

References 32 publications

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“…Stages T3a, T3b and T3c correspond to renal vein, infradiaphragmatic and supradiaphragmatic IVC extension, respectively, with invasion of the IVC wall also considered to be stage T3c [80]. Increasing venous tumour thrombus extension is negatively associated with long-term survival and alters surgical management [79,81,82]. A multi-institutional study of 1122 patients showed a 5-year survival of 22% for stage T3c disease compared to 43.2% for T3a disease [79].…”

Section: Renal Cell Carcinomamentioning

confidence: 99%

“…Patients with adherent tumour thrombus invading the IVC wall require en bloc excision, including segmental resection and reconstruction of the vessel, and tumour thrombectomy. Whilst the majority of radical nephrectomies with venous thrombectomy are performed by open surgery, there is an increasing trend towards minimally invasive laparoscopic and robotic approaches [ 81 ].…”

Section: Secondary Malignancymentioning

confidence: 99%

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The inferior vena cava: anatomical variants and acquired pathologies

Lee

Hall

et al. 2021

Insights Imaging

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The inferior vena cava (IVC) is the largest vein in the body, draining blood from the abdomen, pelvis and lower extremities. This pictorial review summarises normal anatomy and embryological development of the IVC. In addition, we highlight a wide range of anatomical variants, acquired pathologies and a common pitfall in imaging of the IVC. This information is essential for clinical decision making and to reduce misdiagnosis.

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Section: Renal Cell Carcinomamentioning

confidence: 99%

Section: Secondary Malignancymentioning

confidence: 99%

The inferior vena cava: anatomical variants and acquired pathologies

Lee

Hall

et al. 2021

Insights Imaging

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“…Radical nephrectomy combined with resection of inferior vena cava tumor thrombus is the best treatment choice for renal carcinoma with inferior vena cava tumor thrombus ( 2 ), but very little is known about the best surgical approach, and the studies on this particular aspect are limited. Although many classifications have been introduced since Berg performed the first ever RN-IVCT in 1913 ( 7 – 10 ), all of them are used for open surgery ( 14 ). At present, many surgeons use the Mayo classification for the surgical planning and prognosis of these patients.…”

Section: Discussionmentioning

confidence: 99%

The Significant Role of Tumor Volume on the Surgical Approach Choice, Surgical Complexity, and Postoperative Complications in Renal Cell Carcinoma With Venous Tumor Thrombus From a Large Chinese Center Experience

Baheen

Liu²,

Hao³

et al. 2022

Front. Oncol.

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ObjectiveTo explore the role of tumor volume (TV) on surgical approach choice, surgical complexity, and postoperative complications in patients with renal cell carcinoma (RCC) and inferior vena cava tumor thrombus.MethodFrom January 2014 to January 2020, we retrospectively analyzed the clinical data of 132 patients who underwent radical nephrectomy with inferior vena cava thrombectomy (RN-IVCT). Primary renal tumor volume (PRTV), renal vein tumor thrombus volume (RVTTV), inferior vena cava tumor thrombus volume (IVCTTV), and total tumor thrombus volume (TTTV) were measured with the help of an internationally recognized 3D volume measurement software. The patients were divided into three groups according to the tumor volume within the inferior vena cava (IVC). Group 1 included 48 patients with IVCTTV between 0 and 15 cm3 (36.6%), group 2 included 38 patients with IVCTTV between 16 and 30 cm3 (28%), and group 3 included 46 patients with IVCTTV above 30 cm3 (35%). The three IVCTTV groups, as well as four different volume groups, were compared in terms of surgical approach choice, surgical complexity, and postoperative complications. One-way ANOVA and a non-parametric test were used to compare the clinicopathological characteristics and distribution differences between the three groups.ResultThis study found significant differences among the three groups in the proportion of open surgery (P < 0.001), operation time (P < 0.044), intraoperative bleeding (P < 0.001), and postoperative complications (P < 0.001). When the four different volumes were compared, we found that for higher volumes IVCTTV and TTTV, open surgery is used more often compared with laparoscopic surgery (P < 0.001). In addition, with the increase in renal vein tumor thrombus volume, inferior vena cava tumor thrombus volume, and total tumor thrombus volume, the operation time also increased. Finally, with the increase in tumor thrombus volume and total tumor thrombus volume, the amount of intraoperative bleeding increased.ConclusionWith the increase in tumor volume, the proportion of open surgery and the incidence of postoperative complications increased. In addition, larger tumor volume prolongs operation time, increases intraoperative blood loss, and makes the surgery more complicated.

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“…Approximately 10% of patients with RCC present with venous extension of the lesion and 1% will reach above the hepatic veins (Mayo Level 4) [1,2]. While these lesions are often addressed in a single procedure with cardiopulmonary bypass (CPB), with or without deep hypothermic circulatory arrest [2,3], the presentation may be complicated if there is clinical or radiographic evidence of secondary Budd-Chiari syndrome [4]. Operative intervention in such circumstances carries high morbidity and mortality [5].…”

Section: Introductionmentioning

confidence: 99%

A novel two‐stage approach to the treatment of renal cell carcinoma with intra‐cardiac tumour extension and Budd–Chiari syndrome

Perini,

Ischia,

Woon

et al. 2023

BJU International

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ObjectiveTo present the early results of a new technique for the treatment of renal cell carcinoma with intra‐cardiac tumour extension and Budd–Chiari syndrome.Patients and MethodsThe first stage involves transdiaphragmatic debulking of the right heart, inferior vena cava (IVC) and hepatic veins via median sternotomy, followed by a purse‐string suture placed in the IVC below the hepatic veins. The second stage is performed separately and involves en bloc resection of the affected kidney, and IVC and vascular reconstruction via an abdominal incision.ResultsThree of five patients presented with clinical Budd–Chiari syndrome; two had radiological features only. The median time between surgical procedures was 12 days (IQR 13 days). Four of the five patients had a R0 resection. While all five patients successfully completed both operative stages, one patient died 22 days after the second stage. Of the remaining four, all survive with no disease recurrence.ConclusionWhile we continue to compile longer‐term data for a larger follow‐up series, these preliminary findings show the feasibility of this technique and support the development of this programme of surgery.

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Current Trends in Management of Renal Cell Carcinoma with Venous Thrombus Extension

Cited by 20 publications

References 32 publications

The inferior vena cava: anatomical variants and acquired pathologies

The inferior vena cava: anatomical variants and acquired pathologies

The Significant Role of Tumor Volume on the Surgical Approach Choice, Surgical Complexity, and Postoperative Complications in Renal Cell Carcinoma With Venous Tumor Thrombus From a Large Chinese Center Experience

A novel two‐stage approach to the treatment of renal cell carcinoma with intra‐cardiac tumour extension and Budd–Chiari syndrome

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