Surgical outcome following radical nephrectomy in cases with inferior vena cava tumour thrombus extension

Bastian, Patrick J.; Haferkamp, Axel; Akbarov, Ilgar; Albers, Peter; Müller, S. C.

doi:10.1016/j.ejso.2004.12.005

Cited by 11 publications

(10 citation statements)

References 22 publications

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“…The incidence rate of tumorous invasion into the renal vein is 30%, and the incidence of the involvement of the inferior vena cava ranges from 4% to 10% [5] . The study of Bastian et al [6] showed that complication of the renal vein or caval VTE does not decrease the 5-year survivals, so active surgical treatment of the renal carcinoma patients with a tumor embolus complication should be conducted. Since a complete removal of the tumor embolus is needed in order to thoroughly dissociate the renal vein and the inferior vena cava, the scope of the operating fi eld to be exposed has to be enlarged.…”

Section: Discussionmentioning

confidence: 99%

Radical nephrectomy using a chevron incision to treat complicated renal carcinoma: a report of 15 cases

Kang

Zhang

Niu

et al. 2008

Chin. J. Clin. Oncol.

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OBJECTIVE To investigate the outcome and indications for radical nephrectomy with a Chevron incision to treat complicated renal carcinoma. METHODS Large renal carcinomas were found in 15 patients during a preoperative CT and/or MRI examination. A tumor thrombus in the renal vein or inferior vena cava was found in 5 cases, and a complication of metastasis in the contralateral adrenal gland was found in 2 patients. All of the 15 patients underwent a radical nephrectomy by a chevron incision and the postoperative pathological results noted. RESULTSOf the 15 patients who underwent a radical nephrectomy and lymphadenectomy, 5 also received a thrombectomy, and 2 a contralateral adrenalectomy. All surgical operations were safe and successful. The mean operation time was (4.45 ± 0.83) h, and the intraoperative blood loss was (785 ± 910) ml. All patients recovered well a er the surgery. Multimodal therapy was conducted in these cases, with rigorous follow-up. CONCLUSION In determining the type of incision for surgery of renal carcinoma, a chevron incision is suitable for cases with a large tumor, local nodal metastasis, thrombus of the renal vein or inferior vena cava and complicated metastasis to the contralateral adrenal gland. The incision produces a clear operating fi eld with less intra-and post-operative complications.

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Section: Discussionmentioning

confidence: 99%

Radical nephrectomy using a chevron incision to treat complicated renal carcinoma: a report of 15 cases

Kang

Zhang

Niu

et al. 2008

Chin. J. Clin. Oncol.

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“…El trombo tumoral per se no implica un peor pronóstico, a pesar de que tiene un peor comportamiento biológico 1,[13][14][15][16] . En estas series, la extensión craneal del trombo no tuvo influencia en la supervivencia, sin embargo, la presencia de ganglios linfá-ticos y enfermedad metastásica a distancia en el momento del diagnóstico fueron los factores pronósticos principales y los asociados a peor pronósti-co de acuerdo con la literatura [19][20][21] .…”

Section: Discussionunclassified

“…Manejo quirúrgico y pronóstico mente a peor pronóstico [1][2] . La extensión tumoral parece tener mayor efecto pronóstico cuando se comparada con la presencia de trombo tumoral en el sistema venoso [11][12][13][14] .…”

Section: Originalunclassified

“…En 2002, 18.700 nuevos casos fueron diagnosticados en Estados Unidos con 7500 muertes debidos al carcinoma renal de células claras 1 . Entre el 4 y 15% de estos tumores tienen trombo tumoral asociado en la vena renal o en la vena cava inferior (VCI) y el tipo histológico más frecuente en los tumores con trombo tumoral asociado es el Carcinoma de Células Renales (CCR) [5][6][7][8][9] .…”

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Tumor renal con trombo en la vena cava inferior: Manejo quirúrgico y pronóstico

et al. 2009

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ResumenObjetivos: el objetivo del presente estudio fue evaluar las estrategias usadas para el manejo quirúrgico del cáncer de renal con extensión de trombo a la vena cava inferior y evaluar el pronóstico del paciente. Métodos: Quince pacientes con cáncer renal y trombo en la vena cava inferior fueron sometidos a una nefrectomía radical y trombectomía y fueron evaluados de forma retrospectiva. Los pacientes fueron seguidos desde 0 a 36 meses (media de 9,5 meses). La tomografía computada con reconstrucción tridimensional fue usada para definir el nivel del trombo. Resultados: La edad media fue de 54 años, con un rango de entre 16 y 79 años. El trombo fue clasificado como de nivel I (13,5%), nivel II (40%), nivel III (26,5%) y nivel IV (20%). La cirugía fue llevada a cabo mediante by pass cardiopulmonar en seis casos, tres de los cuales sin esternotomía. Hubo una muerte intraoperatoria (13%) en un paciente que presentaba enfermedad metastásica con un trombo que alcanzaba la aurícula derecha. Los pacientes con ganglios positivos o enfermedad metastásica como presentación inicial tenían peor supervivencia global en la curva de Kaplan-Meier. Ambos, estadiaje tumoral (p = 0,380), y extensión del trombo (p = 0,174) no tuvieron relación con la supervivencia. Conclusiones: A pesar de su morbilidad y mortalidad, la nefrectomía radical y la trombectomía deberían ser llevadas a cabo en casos de carcinoma renal con trombo tumoral, porque puede ofrecer la posibilidad de control local de la enfermedad. Los pacientes con ganglios linfáticos y enfermedad metastásica tienen peor pronóstico.Palabras clave: Trombo vena cava inferior. Tumor renal. Pronóstico y manejo quirúrgico. Renal tumor with inferior vena cava thrombus. Surgical approach and prognosis AbstractObjectives: The aim of this study was to evaluate strategies used for surgical management of renal cell carcinoma with tumoral thrombus extension in the inferior vena cava (IVC) and evaluate patient's prognosis. Metods: Fifteen patients with renal tumor and IVC thrombus, underwent radical nephrectomy and thrombectomy, and were retrospectively evaluated. Patients were followed for 0 to 36 months (mean of 9.5 months). Computed tomography (CT) scan with three-dimensional reconstruction was used to define IVC thrombus level. Results: The mean age was 54 years, range from 16 to 79. The thrombus was classified as level I -13.5%, level II -40%, level III -26.5% and level IV -20%. Surgery was performed with cardiopulmonary bypass (CPB) in six (40%) cases, three (50%) without sternotomy. There was one (13%) death during the intraoperative period; this patient presented extensive metastatic tumor, with the thrombus reaching the right atrium. Patients with lymph node or metastatic disease at initial presentation had poorer overall survival in Kaplan-Meier curve. Both, tumor stage (p = 0.380), and thrombus extension (p = 0.174) were not related to survival. Conclusions: Despite its morbidity and mortality, radical nephrectomy with thrombectomy should be performed in case of renal cell c...

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“…Advances in surgical techniques and perioperative care over the last 30 years currently ensure safe care [5,6]. The treatment strategy is radical nephrectomy with thrombectomy and extended lymphadenectomy [7].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors in Renal Cell Carcinoma With Vena Cava Extension

Rioja¹,

Mayans²,

Bergera³

et al. 2010

UIJ

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Abbreviations and AcronymsECC = extracorporeal circulation IVC = inferior vena cava RCC = renal cell carcinoma. ABSTRACT INTRODUCTION: The objectives were to: (1) analyze clinical and pathological features of renal cell carcinoma (RCC) with caval thrombosis in order to indentify independent prognostic factors, and (2) analyze perioperative morbidity and mortality. METHODS:The authors retrospectively analyzed clinical and pathological data of 56 patients treated for RCC with caval thrombosis during a 20-year period. The surgical procedure was essentially unchanged. Independent variables were: TNM, creatinine value, age, histological extent, histological type, adjuvant treatment, and surgical technique; the dependent variable was overall survival. Contingency and logistic regression tables were used.Kaplan-Meier method, log-rank, and Cox models were used to analyze survival rates.RESULTS: There were complications in 15 patients and 2 perioperative deaths. Overall mean (SD) survival rates were 32% (7%) and 24% (6%) at 3 and 5 years, respectively. Multivariate results showed that the significant prognostic indicators of survival were: the size of the tumor > 8 cm (P < .01), the presence of metastasis (P < .04), and lymph node invasion (P < .009). These were also regarded as the relevant variables, independent of patient survival. CONCLUSIONS:The surgical approach for this disorder is challenging and not exempt of complications. Nodal involvement, tumor size, and distant metastases are the most important prognostic factors; thrombus extension has a clear impact on surgical planning and performance. UroToday International Journal ® UI J

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Surgical outcome following radical nephrectomy in cases with inferior vena cava tumour thrombus extension

Cited by 11 publications

References 22 publications

Radical nephrectomy using a chevron incision to treat complicated renal carcinoma: a report of 15 cases

Radical nephrectomy using a chevron incision to treat complicated renal carcinoma: a report of 15 cases

Tumor renal con trombo en la vena cava inferior: Manejo quirúrgico y pronóstico

Prognostic Factors in Renal Cell Carcinoma With Vena Cava Extension

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