Outcomes of Laparoscopic Radical Nephrectomy in the Setting of Vena Caval and Renal Vein Thrombus: Seven-Year Experience

Martin, George L.; Castle, Erik P.; Martin, Aaron; Desai, Premal J.; Lallas, Costas D.; Ferrigni, Robert G.; Andrews, Paul

doi:10.1089/end.2008.0035

Cited by 59 publications

(29 citation statements)

References 16 publications

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“…However, current literature examining outcomes in this patient population are limited to small, single-centre analyses. [15][16][17][18][19] In this study using a large, multi-institutional design in a contemporary cohort, we described the oncological outcomes of patients with locally advanced, non-metastatic RCC treated laparoscopically.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort

Nayak

Patel

Bjazevic

et al. 2015

CUAJ

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Introduction: We described the clinical and oncological outcomes of patients treated by laparoscopic surgery for non-metastatic pT3 renal cell carcinoma (RCC). Methods: We queried a multi-institutional database for patients diagnosed with non-metastatic pathological T3 RCC from 13 Canadian centres treated laparoscopically (radical or partial nephrectomy) between 2008 and 2014. Clinical and pathological outcomes were evaluated. Progression was defined as the development of recurrence or metastatic disease. Log-rank testing and Kaplan-Meier statistical methods assessed for differences and estimated progression-free survival (PFS). Results: In total, 176 patients were identified with a median age of 64 years. The median tumour size was 7.0 cm. Pre-clinical stage was cT1 to cT4 in 39%, 28%, 30% and 3%, respectively. The median blood loss was 150 mL (range: 0-6000) and the median operative time was 124 minutes (range: 60-360). Most lesions were clear cell RCC (80%). After a median follow-up of 17.6 months (range: 0.2-75.0), disease progression occurred in 26% (46/176) of patients, consisting of local recurrence in 7% (3/46), and metastatic disease in 93% (43/46). The 3-year PFS was 67%, with a median PFS of 49 months. Of those who progressed, the median time to progression was 10.3 months. Conclusions: This study is the largest cohort of pT3 RCC patients treated laparoscopically in the literature and suggests that for properly selected patients, laparoscopic management of locally advanced renal masses yields acceptable short-term oncological outcomes.

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Section: Introductionmentioning

confidence: 99%

Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort

Nayak

Patel

Bjazevic

et al. 2015

CUAJ

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“…Einzelne Berichte zeigen jedoch, dass in den Händen eines erfahrenen Laparoskopeurs auch größe-re renale Massen laparoskopisch entfernt werden können [11]. Auch scheint eine Invasion der Nierenvene nicht mehr eine absolute Kontraindikation zu sein, solange ein sicherer tumorfreier Abstand zur Einmündungsstelle in die V. cava besteht [12]. Einzelne Berichte existieren inzwischen auch für die laparoskopische Resektion von großen Nierentumoren in Patienten mit fortgeschrittenen Erkrankungen, bei denen eine adjuvante Immuntherapie geplant wurde [13].…”

Section: Indikationen Und Kontraindikationenunclassified

Nephrektomie – pro laparoskopisch

Hoda

Fornara

2012

Urologe

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Laparoscopic radical nephrectomy (LRN) is considered as a standard of care for T2 renal masses and T1 tumors not treatable by nephron-sparing surgery. It can be performed transperitoneally, retroperitoneoscopic or hand-assisted. However, the morbidity after laparoscopic nephrectomy has been shown to be lower than the open procedure and patients seem to benefit from early mobilization, less pain medication, shorter hospital stays and an earlier return to normal daily activities. Furthermore, the extent of perioperative activation of the systemic stress response appears to be less during laparoscopic procedures. This has been shown to have evidently beneficial clinical impact on patient's recovery; however, its importance for the oncologic prognosis is somewhat unclear. In addition, the progression-free and overall tumor-specific survival rates for laparoscopic nephrectomy are equivalent to those for open surgery. The experiences with robot-assistance for laparoscopic nephrectomy reported so far show no significant advantages over traditional laparoscopic nephrectomy. However, the problem of high costs of acquisition and operation of robots still remains unsolved. For the future, prospective studies are needed in order to compare the functional and oncological outcomes and cost-effectiveness of different methods of radical nephrectomy.

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“…Some have questioned its benefits [28][29][30][31] while others have used laparoscopy for IVC tumor thrombi using open incisions for tumor thrombectomy after laparoscopic mobilization and dissection [32][33][34] or pure laparoscopy with hand assistance for the thrombectomy only [35]. Single case reports have also been described using hand-assisted or pure laparoscopy for short thrombi [36,37], recently few case reports and one case series of robotic IVC thrombectomy has been reported in the literature [38].We await results of larger series since robotic and laparoscopic IVC tumor thrombectomy remain a challenging procedure and should not be embarked on lightly and hence open surgery remains the predominant method for addressing RCC involving the IVC.…”

Section: Minimal Invasive Techniquesmentioning

confidence: 99%

“…Since our series expands nearly two decades the complication were higher in earlier period. Minimal invasive techniques are being propagated as an effective alternative in reducing morbidity [32][33][34][35][36][37][38].…”

Section: Mortality and Morbiditymentioning

confidence: 99%

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

Kulkarni

Jadhav

Valsangkar

2011

Indian J Surg Oncol

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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.

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Outcomes of Laparoscopic Radical Nephrectomy in the Setting of Vena Caval and Renal Vein Thrombus: Seven-Year Experience

Cited by 59 publications

References 16 publications

Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort

Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort

Nephrektomie – pro laparoskopisch

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

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