Renal cell carcinoma extending to the renal vein and inferior vena cava: Results of surgical treatment and prognostic factors

Abstract

Forty-seven patients with renal cell carcinoma with tumor thrombus extension to the renal vein or inferior vena cava (IVC) were treated surgically over a 10-year period. There were 41 males and 6 females with a mean age of 45.7 years. Thirty-three patients had right-sided and 14 had left-sided tumors. Patients with renal vein or infrahepatic IVC thrombus were treated with radical nephrectomy with tumor thrombus excision after achieving conventional vascular control over the IVC and the opposite renal vein. Four patients with retrohepatic IVC thrombus were treated with venacavotomy and thrombectomy after achieving vascular control above the thrombus but below the hepatic veins while two other patients with retrohepatic and one with suprahepatic thrombus required a bifemoroatrial partial venous bypass prior to tumor thrombectomy. There was one postoperative death due to pulmonary embolism. The actuarial 5-year survival for all patients with venous extention was 50% and the median survival was 4.35 years. Perinephric spread and lymph node metastases were significant prognostic factors affecting survival. This suggests that it is the locoregional spread of renal cell carcinoma rather than the level of the thrombus which governs the prognosis of patients with tumor thrombus extension to the renal vein or IVC. 0 1995 Wiley-Liss, Inc.

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

“…Moreover as in literature [10,41] grade II tumors had better prognosis as compared to grade IV (75.39% vs 23.52%, P<0.05, statistically significant). Local stage is probably most important prognostic factor; (40,41,42) in our series, 74.13% patient without perinephric fat involvement were free from disease as compared to 30% with perinephric fat involvement. (P<0.01, statistically significant).…”

“…Several pathologic prognostic factors are mentioned in the literature [6,11,[40][41][42][43], including mainly the local stage of the tumor, histological type and grade of tumor and presence of vascular invasion, vessel wall invasion, adrenal and pelvicalyceal involvement.…”

Prognostic Impact of Perirenal Fat or Adrenal Gland Involvement in Renal Cell Carcinoma Exhibiting Venous Vascular Extension

“…Thus, additional prognostic factors are needed. For RCCs exhibiting venous vascular extension, several investigators have described the prognostic significance of the level of venous extension (Hatcher et al, 1991;Ljungberg et al, 1995;Tongaonkar et al, 1995;Glazer & Novick, 1996;Kuczyk et al, 1997;Staehler & Brkovic, 2000). Most recent series have reported that the level of tumor thrombosis in the inferior vena cava does not significantly effect long-term survival (Kim et al, 2004;Moinzadeh & Libertino, 2004).…”

“…On univariate analyses, perirenal fat or adrenal gland involvement, preoperative metastasis, positive lymph node metastasis, and spindle cell factor were significant predictors of poor prognosis. Metastatic disease has been reported as an adverse predictor of disease-specific survival by several investigators (Neves & Zincke, 1987;Hatcher et al, 1991;Swierzewski et al, 1994;Tongaonkar et al, 1995;Nesbitt et al, 1997;Gettman et al, 2003). Generally, histological grade is identified as an independent prognostic factor in all RCCs (Méjean at al., 2003), but our results suggest histological grade does not affect survival in patients specifically having RCCs exhibiting tumor thrombus with perirenal fat or adrenal gland involvement.…”

Hand-assisted laparoscopic radical nephrectomy in the treatment of a renal cell carcinoma with a level ii vena cava thrombus

“…After discussion of its risks and potential survival benefit (13,14), cytoreductive nephrectomy was performed. The authors were prepared to perform a laparoscopic hand assisted nephrectomy with vascular control through a Gel Port ® (Applied Medical, Rancho Santa Margarita, California).…”