Surgical Management and Outcome of Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus

Abstract

Introduction: The authors of this paper assessed the surgical management and outcome of renal cancers when tumor thrombus extended into the inferior vena cava (IVC). Methods: From 2000 to 2015, 46 radical nephrectomies were performed on patients with tumor thrombus in the IVC. The mean age of the patients was 60 ± 11 years. Radical nephrectomy and thrombectomies were performed in a single session. There were 18 level-IV, 23 level-III, and 5 level-II tumor thrombi. The operations were performed using cardiopulmonary bypass in 14 patients, while deep hypothermic cardiac arrest was carried out in 4 cases. Results: The mean size of the tumors was 9.4 ± 3.5 cm. Histology showed the tumor stages to be pT3b in 21cases, pT3c in 22, and pT4 in 3 patients. The mean follow-up period of the patients was 3.6 ± 3.0 years. During the follow-up period, local recurrence was observed in 7 patients, while distant metastases occurred in 8 cases. The median time to progression was 37 ± 27 months. The 5-year overall survival was 43.7%. Conclusions: Radical nephrectomy and thrombectomy provided reasonable long-term survival for patients with renal cancer and IVC thrombus. However, tumor progression was detected in 41.6%. The presence of tumor thrombus had a negative effect on tumor progression and survival.

Surgical complexity and prognostic outcome of small volume renal cell carcinoma with high-level venous tumor thrombus and large volume renal cell carcinoma with low-level thrombus

“…Some believed the presence of IVC tumor thrombus affected the prognosis with poor prognosis, [15] while others believed that tumor thrombus had little effect on prognosis. [16,17]…”

Surgical treatment for Xp11.2 translocation renal cell carcinoma with venous thrombus

“…[28] Most of the studies favoring surgical intervention were based on large series ccRCC patients with tumor thrombus. [18,29] Comparing with non-tRCC group, our analysis demonstrated a comparable OS rate in tRCC patients. It suggests that aggressive surgery could be offered for tRCC patients with thrombus.…”

Sunitinib cause delayed complete response on metastatic RCC and extensive IVC thrombus, but not to the kidney tumor: a case report and review of literature

“…IVC tumor thrombus formation in RCC patients is a significant adverse prognostic factor, necessitating an aggressive surgical resection. Many studied have confirmed good outcomes of this extensive surgery for patients with good performance status and absent distant metastases [4]. Sunitinib is an oral tyrosine kinase inhibitor (TKI) that has anti-tumor and anti-angiogenic activity.…”