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

Abstract

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.

Robust response to nivolumab in patient with renal cell carcinoma inferior vena cava tumour thrombus

“…IVC tumour thrombus has historically been classified using the Mayo system: level I is defined as <2 cm from the confluence of the renal vein and IVC; level II indicates >2 cm extension, but below hepatic veins; level III indicates intrahepatic involvement and level IV indicates that the thrombus extends supra-diaphragmatic or involves the right atrium 2. At presentation, our patient had an extensive level II thrombus, almost extending to level III.…”

Supradiaphragmatic Inferior Vena Caval Thrombectomy Without Cardiopulmonary Bypass: A Case Series at a Single Center

“…RCC with vena caval extension is infrequent, but when it occurs, it necessitates an aggressive approach by a surgical team with extensive experience in urological cancer surgery (1, 12). The standard treatment for advanced tumor thrombi is radical nephrectomy and thrombectomy via laparotomy and midsternotomy incisions with atriotomy.…”

“…Renal cell carcinoma (RCC) is unique among urologic tumors because of its potential for tumor thrombus formation and migration into the venous system (1). This develops in approximately 4% - 10% of cases (2) and some (2% - 10%) may extend up to the right atrium (3).…”

Prognostic Benefit of Surgical Management of Renal Cell Carcinoma Invading the Inferior Vena Cava

“…Consequently, RCC is divided into 5 main histologic subtypes: clear cell, papillary, chromophobe, collecting duct and unclassified [19]. The most commonly described lesion (70-80 %) is Clear Cell RCC (CCRCC) which is originates from the proximal convoluted tubule.…”