Renal cell carcinoma with tumor thrombus: A review of relevant anatomy and surgical techniques for the general urologist

Almatari, Abraham L.; Sathe, Aditya; Wideman, Lauren; Dewan, Christian A.; Vaughan, Joseph P.; Bennie, Ian C.; Buscarini, Maurizio

doi:10.1016/j.urolonc.2022.11.021

Cited by 21 publications

(24 citation statements)

References 41 publications

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“…All RCC cases with IVC TT require preoperative follow-up imaging at an appropriate time to allow for planning the treatment, especially when rapid growth of the tumor embolus occurs prior to surgery. 1 Almatari et al suggested that it is preferable for surgeons to perform weekly imaging evaluations prior to surgery to detect unexpected growth of IVC TT. 1 However, frequent imaging examinations are time-consuming and place an economic burden on the patient.…”

Section: Discussionmentioning

confidence: 99%

“…1 Almatari et al suggested that it is preferable for surgeons to perform weekly imaging evaluations prior to surgery to detect unexpected growth of IVC TT. 1 However, frequent imaging examinations are time-consuming and place an economic burden on the patient. Our institution decided to perform follow-up ultrasonography for IVC TT evaluation 2 weeks, 1 week, and 1 day prior to surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative imaging evaluation of the IVC TT is important because it is significantly associated with surgical procedures. Multidetector CT and MRI are reportedly useful in evaluating the level of IVC TT 1 . On the other hand, ultrasonography is noninvasive and commonly used in the evaluation of RCC, but its accuracy is highly dependent on the skill of the sonographer and the location of the IVC TT 1 .…”

Section: Discussionmentioning

confidence: 99%

“…At diagnosis, 4% to 10% of RCC have an IVC TT 1,2 . Surgery for RCC with IVC TT is a highly invasive procedure because of the need to treat the IVC and a large amount of bleeding due to well‐developed collateral vessels.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, radical resection of RCC, including IVC TT, is the standard treatment for nonmetastatic RCC with IVC TT. The surgical difficulty of IVC TT surgery varies depending on the level of the TT: Level 0 IVC TT may be treated with simple renal vein ligation, whereas level 4 IVC TT requires surgery in collaboration with different surgical teams 1 . Especially, level 4 IVC TT generally requires more extensive surgical procedures including thoracotomy.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative rapid growth of inferior vena cava tumor thrombus in renal cell carcinoma

Katsu,

Yanagi,

Yoshioka

et al. 2024

IJU Case Reports

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IntroductionWe present the case of a rapidly growing inferior vena cava tumor thrombus in renal cell carcinoma.Case presentationWe present a case of a 66‐year‐old woman with right renal cell carcinoma with a tumor thrombus extending 2 cm into the inferior vena cava on an initial Imaging. Radical surgery was performed 6 weeks after the first visit. Intraoperatively, the tumor thrombus was confirmed to have grown near the diaphragm. The tumor was resected using an inferior vena cava clamping just below the diaphragm. The tumor thrombus and renal cell carcinoma were completely removed. There was no recurrence 6 months postoperatively.ConclusionInferior vena cava tumor thrombus in renal cell carcinoma can grow in a short period, suggesting that preoperative imaging evaluation at the appropriate time is important. Once inferior vena cava tumor thrombus of renal cell carcinoma occurs, surgery should not be delayed unless there is an urgent reason.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Preoperative rapid growth of inferior vena cava tumor thrombus in renal cell carcinoma

Katsu,

Yanagi,

Yoshioka

et al. 2024

IJU Case Reports

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Utilization of cardiopulmonary bypass at radical nephrectomy for renal cell carcinoma with tumour thrombus

Suk‐Ouichai,

Huang,

Neill

et al. 2024

BJUI Compass

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ObjectivesThe objective of this study is to evaluate preoperative factors associated with cardiopulmonary bypass (CPB) utilization and outcomes for patients with renal cell carcinoma (RCC) and tumour thrombus (TT). Radical nephrectomy with thrombectomy is a standard treatment for patients with RCC and associated TT. Morbidity and mortality rates tend to correlate with aggressiveness of tumour and TT level.MethodsPatients undergoing radical nephrectomy with thrombectomy (2006–2023) were retrospectively identified. Inclusion criteria included RCC histology and preoperative imaging available for thrombus‐level categorization based on the Mayo Clinic grading system. Logistic regression assessed predictors for utilizing CPB, and Cox regression identified factors associated with survival.ResultsA total of 72 patients with RCC and associated TT were identified. The median age was 67 years. RCC‐related symptoms were present in 83%, and 28% had Levels 3 and 4 thrombi. Eleven patients (15.3%) had undergone neoadjuvant therapy, and 81% had clear‐cell RCC. CPB was utilized in eight (11.1%) cases. The median tumour size was 10.5 cm. Metastatic disease was greater in the CPB cohort (75% vs. 28%, p = 0.008). All cases performed on CPB were Levels 3 and 4 thrombi (100% vs. 19% in the non‐CPB group, p < 0.001). CPB cases had significantly longer operative time, and hospital stays and rates of Clavien ≥ 3 complications. On multivariate analysis, metastatic disease was a predictor of CPB utilization. Median survival was 74 and 25 months in the non‐CPB and CPB cohorts, respectively (p = 0.01). Pulmonary disease and metastatic disease with CPB utilization were significantly associated with worse survival on multivariate analysis.ConclusionsSurgical extirpation of kidney tumours with associated TT remains the standard of care among patients with locally advanced RCC. CPB can be utilized to increase the feasibility of resection for high‐level thrombi. Preoperative planning and cooperation among surgical teams are key given the perioperative morbidity and mortality.

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Defining a threshold for safe surgical management of vena cava thrombus in renal cell carcinoma patients: evidence from German total population data with 3,700 cases from 2006 to 2020

Martin,

Huber,

Koch

et al. 2024

World J Urol

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Purpose The management of inferior vena cava (IVC) tumor thrombus in patients with renal cell carcinoma (RCC) is among the most challenging surgical procedures. We aimed to define a minimum annual caseload for sufficient expertise. Methods We identified all cases with RCC, nephrectomy, and IVC procedures in the Federal Statistical Office billing database (2006–2020). We defined annual hospital caseload categories as low (< 4 cases), medium (4–9 cases) and high (> 9 cases) volume. Logistic multivariate models identified mortality-related factors. In addition, we analyzed data on tumor stage distribution from German cancer registries. Results We recorded 3,700 nephrectomies with IVC-tumor resection with stable annual case number of 247 mean. This correlated with a stable incidence of T3b/c RCC. Patient age was 66 ± 14 years. Of all cases, 56% occurred in low, 30% in medium, and 14% in high volume clinics without a significant trend towards centralization. The overall in-hospital mortality rate was 5.8% and the transfusion rate 72%. An annual caseload of 8 showed to be a significant cut-off for mortality with 6.2% at < 8 cases and 2.8% for > = 8 cases annually (p < 0.001). Multivariate analysis revealed patient age (OR 6.4 for octogenerians) ventilation time (OR 14.3 for > 24 h) and hospital caseload (OR 2.6) as the most important risk factors for in-hospital mortality. Conclusion Our results show a negative correlation of annual caseload and mortality for this procedure. A minimum number of 8 procedures per year seems reasonable for the successful management of IVC tumor thrombus with significantly lower mortality.

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Renal cell carcinoma with tumor thrombus: A review of relevant anatomy and surgical techniques for the general urologist

Cited by 21 publications

References 41 publications

Preoperative rapid growth of inferior vena cava tumor thrombus in renal cell carcinoma

Preoperative rapid growth of inferior vena cava tumor thrombus in renal cell carcinoma

Utilization of cardiopulmonary bypass at radical nephrectomy for renal cell carcinoma with tumour thrombus

Defining a threshold for safe surgical management of vena cava thrombus in renal cell carcinoma patients: evidence from German total population data with 3,700 cases from 2006 to 2020

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