Long-term Survival in Patients Undergoing Radical Nephrectomy and Inferior Vena Cava Thrombectomy: Single-Center Experience

Ciancio, Gaetano; Manoharan, Murugesan; Katkoori, Devendar; Santos, Rosely De Los; Soloway, Mark S.

doi:10.1016/j.eururo.2009.06.009

Cited by 149 publications

(141 citation statements)

References 24 publications

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“…The mean age was 59.2 ± 12.2 years (range: 38-76). The mean tumour diameter was 12.8 ± 3.4 cm (range: [6][7][8][9][10][11][12][13][14][15][16][17] and the mean size of the tumour thrombus in the proximal end IVC was 11.6 ± 1.9 cm (range: 9-15). Preoperative chest, abdomen, and pelvic computed tomography (CT) scan, upper abdominal 3-dimensional imaging, and IVC angiography were performed on all patients (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…The 5-year overall survival across stages ranges from 30% to 60%. [5][6][7][8] Cases with lymph node involvement or distant metastasis are associated with poor prognosis. 9 Previous studies reported that radical nephrectomy and removal of thrombus carries a mortality rate of 5% to 12.5%, depending on concomitant diseases and characteristics of the tumour thrombus.…”

Section: Introductionmentioning

confidence: 99%

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Precise control of caval and hepatic vessels: Surgical technique to treat level III caval thrombus concomitant to renal cell carcinoma

Chen

Liu

et al. 2015

CUAJ

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E808Cite as: Can Urol Assoc J 2015;9(11-12):E808-13. http://dx.doi.org/10.5489/cuaj.3074 Published online November 4, 2015. AbstractIntroduction: We investigated the surgical techniques, safety, and prevention of complications of nephrectomy and removal of tumour thrombus for treating level III inferior vena cava (IVC) concomitant to renal cell carcinoma (RCC). We did this by precise controlling IVC and hepatic vessels without a vascular bypass. Methods: In this series, we included 5 patients with level III IVC tumour thrombus below the hepatic vein concomitant to RCC. After precisely controlling the IVC and hepatic vessels, we then removed the thrombus en bloc with the renal vein. Blood loss volume, IVC clamping time, hypotension time, resuscitation, cardiocerebrovascular complications, and postoperative organ dysfunction were observed. Results: Surgery was successfully performed without perioperative death. Blood loss volume was 900 to 1500 mL, operation time was 165 to 250 minutes, vascular clamping time was 8 to 12 minutes, and intraoperative hypotension time was 9 to 12 minutes. Serious perioperative complications were not observed. Local recurrence was not observed during the 9 to 24 months of follow-up. One patient exhibited disease-free survival, 3 developed lung or liver metastasis, and 1 died 11 months after surgery. Conclusion: Precise control of IVC and hepatic pedicle vessels, without vascular bypass, is a safe and effective surgical treatment for level III tumor thrombus below the hepatic vein concomitant to RCC. The procedure was conducted without increased risks of intraoperative hypotensive shock, difficult resuscitation, pulmonary embolism, and multiple organ dysfunctions.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Precise control of caval and hepatic vessels: Surgical technique to treat level III caval thrombus concomitant to renal cell carcinoma

Chen

Liu

et al. 2015

CUAJ

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“…'Rx Surgery Primary Site 1998 + ' was used to identify the type of surgery as follows: no surgery (0), ablation (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), partial nephrectomy (26-39), radical nephrectomy (40-89), nephrectomy not otherwise specified (90) and unknown (99). Patients undergoing no surgery or ablation were combined into a no surgery group, whereas patients treated with partial nephrectomy, radical nephrectomy or nephrectomy not otherwise specified were combined into a surgery group.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with surgery in patients with renal cell carcinoma and venous tumor thrombus

2010

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• Univariable and multivariable logistic regression analysis was performed to identify factors associated with surgery. RESULTS• We identified 24 396 patients with RCC, of which 2265 (9.3%) had venous tumour thrombus.• CONCLUSIONS• In this population-based study, over 80% of patients with RCC and venous tumour thrombus underwent surgical management.• Although age and TNM stage were strongly associated with the decision to undergo surgery, marital status was also associated with treatment choice.• It is unclear whether marital status affects oncological outcomes or complication rates so the reasons behind this association deserve further investigation.

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“…The use of deep hypothermia, in which the patient is cooled to less than 30°C, may be employed concurrently with cardiopulmonary bypass to prevent ischemic sequelae associated with circulatory arrest and temporary interruption of the bypass circuit while the thrombus is extracted [Chowdhury et al 2007]. Although hypothermic circulatory arrest has been associated with perioperative mortality rates of 3-16% among patients undergoing tumor thrombectomy [Ciancio et al 2010a], a recent multi-institutional series of 162 patients with level III and IV tumor thrombus found no association between cardiopulmonary bypass or deep hypothermic circulatory arrest and postsurgical complications or mortality following tumor thrombectomy on multivariate analysis [Abel et al 2013b]. …”

Section: Perioperative Monitoring and The Role For Vascular Bypassmentioning

confidence: 99%

Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma

Psutka

Leibovich

2015

Therapeutic Advances in Urology

124

105

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Abstract:The diagnosis of renal cell carcinoma is accompanied by intravascular tumor thrombus in up to 10% of cases, of which nearly one-third of patients also have concurrent metastatic disease. Surgical resection in the form of radical nephrectomy and caval thrombectomy represents the only option to obtain local control of the disease and is associated with durable oncologic control in approximately half of these patients. The objective of this clinical review is to outline the preoperative evaluation for, and operative management of patients with locally advanced renal cell carcinoma with venous tumor thrombi involving the inferior vena cava. Cornerstones of the management of these complex patients include obtaining high-quality imaging to characterize the renal mass and tumor thrombus preoperatively, with further intraoperative real-time evaluation using transesophageal echocardiography, careful surgical planning, and a multidisciplinary approach. Operative management of patients with high-level caval thrombi should be undertaken in high-volume centers by surgical teams with capacity for bypass and invasive intraoperative monitoring. In patients with metastatic disease at presentation, cytoreductive nephrectomy and tumor thrombectomy may be safely performed with simultaneous metastasectomy if possible. In the absence of level one evidence, neoadjuvant targeted therapy should continue to be viewed as experimental and should be employed under the auspices of a clinical trial. However, in patients with significant risk factors for postoperative complications and mortality, and especially in those with metastatic disease, consultation with medical oncology and frontline targeted therapy may be considered.

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Long-term Survival in Patients Undergoing Radical Nephrectomy and Inferior Vena Cava Thrombectomy: Single-Center Experience

Cited by 149 publications

References 24 publications

Precise control of caval and hepatic vessels: Surgical technique to treat level III caval thrombus concomitant to renal cell carcinoma

Precise control of caval and hepatic vessels: Surgical technique to treat level III caval thrombus concomitant to renal cell carcinoma

Factors associated with surgery in patients with renal cell carcinoma and venous tumor thrombus

Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma

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