Perioperative and oncological outcomes of renal cell carcinoma with venous tumour thrombus

Abstract

Aim: The aim of the present study is to report the perioperative and long-term surgical outcomes of renal cell carcinoma (RCC) with venous tumour thrombus (VTT). Materials and methods: Data of 34 patients (males = 23, females = 11) from 2009 to 2020 who underwent radical nephrectomy with thrombectomy for RCC and VTT was retrospectively analysed. The parameters recorded include tumour laterality, size, level of thrombus, surgical approach, blood loss, transfusion rates, operative time, hospital stay, Clavien complications, tumour histology, follow-up duration, local recurrence, distant metastasis, overall and cancer-specific survival rates. Results: The extent of thrombus was level I in thirteen, level II in twelve, level III (a-1, b-2, c-1, d-2) in six and level IV in three patients respectively. Mean operative time was 320 (±145) min, mean blood loss was 1371.15 (±1020.8) ml and mean hospital stay was 9.6 (±7.4) days. Mean transfusion rate was 6.4 (±3.2) units. Three patients died within the first 30 days of surgery. Cardiopulmonary bypass (CPB) was utilized in three patients. Median follow-up period was 58 (Range: 4–101) months. A statistically significant correlation was found between operative time ( p = 0.014) and median survival ( p = 0.003) respectively and tumour thrombosis level. Nine patients died due to metastasis, and ten due to unrelated causes. The estimated actuarial survival rates at a median of 58 months were 35.3%. Conclusion: An accurate preoperative assessment of the thrombus extent with the involvement of a multidisciplinary team approach is crucial in achieving optimal surgical outcomes in patients of RCC with VTT, particularly with level III and IV thrombus.

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

“…VTT was con rmed to have signi cant in uence on the prognosis of RCC patients [29][30][31][32]. In the study of Blute et al…”

“…It reveals that patients with higher tumor thrombus level would have more possibility to get early postoperative complications including renal insu ciency. So more accurate preoperative assessment of the thrombus extent and location is crucial in achieving optimal surgical outcomes in patients of RCC with VTT, particularly with higher level (level and ) thrombus [31]. Furthermore, Ebbing et al [24] found that the main risk factor for severe early postoperative complications in the univariate (OR, 16.421; 95% CI, 2.117-127.359; P=0.007) and multivariate (OR, 11.847; 95% CI, 1.469-95.560; P=0.020) analyses was supradiaphragmatic tumor thrombus (level tumor thrombus).…”

Renal Sinus Pathologies Depicted by CT Imaging: A Pictorial Review

“…Most cases of RCC grow by expansion and can often extend into the renal pelvis, causing focal hydronephrosis or displacement of the caliceal. In contrast to TCC, RCC has a tendency to spread into the venous system [12].…”