Key result
Nephrectomy with segmental or subtotal cavectomy in patients with renal cell carcinoma and massive inferior vena cava tumor invasion achieved a 5-year overall survival of 54.6%.
Why the study?
Does nephrectomy with circular IVC resection provide satisfactory survival and functional outcomes in patients with RCC and advanced IVC tumor invasion?
Observational (n=49)
No
Does nephrectomy with circular IVC resection provide satisfactory survival and functional outcomes in patients with RCC and advanced IVC tumor invasion?
Nephrectomy with segmental/subtotal cavectomy is an effective treatment for RCC with advanced IVC invasion, yielding a 5-year overall survival of 54.6% despite high surgical morbidity.
May support aggressive resection in select RCC cases with extensive IVC invasion; leaves open need for controlled trials on morbidity and outcomes.
Objective. To evaluate short-term and long-term results of nephrectomy, thrombectomy, circular inferior vena cava (IVC) resection in patients with renal cell carcinoma (RCC) and advanced IVC tumor invasion.Materials and methods. Medical data of 49 patients with RCC and level II–IV tumor venous thrombus with advanced IVC wall tumor invasion were analyzed. All the patients underwent nephrectomy, thrombectomy, circular IVC resection (radical – 35 (71.0 %), cytoreductive, in M+ cases – 14 (28.6 %)). Circular resection of the infrarenal IVC segment was performed in 25 (51.0 %) patients; resection of the infrarenal, perirenal and retrohepatic IVC segments with a ligation of the left renal vein (RV) – in 24 (49.0 %) patients. Perirenal IVC prosthesis was used in 2 (4.1 %) patients with initially preserved IVC blood flow, in other cases replacement of the removed IVC segment wasn’t performed due to presence of a network of venous collaterals duplicating the IVC. Patients with metastases received systemic antitumor treatment after nephrectomy, thrombectomy.Results. Median operative time was 260 (135–580) minutes, median blood loss was 8750 (3000–27 000) ml. Severe intraoperative complications were observed in 2 (4.0 %) patients, 1 (2.0 %) patient died on the operating table due to hypovolemic shock. Postoperative complications were observed in 26 (53.2 %) cases (grade III–V in 22 (45.8 %) patients). Five-year overall and cancer-specific survival of all patients was 54.6 and 67.8 %, respectively, relapse-free survival of 35 patients with M0 category was 49.4 %. Both IVC prostheses were patent 12 months after the surgery. Function of the left kidney after ligation of the left RV was preserved at the preoperative level in all 24 patients in a median of 12 (2–120) months.Conclusion. Nephrectomy, segmental/subtotal cavectomy with preservation of the main renal venous entries is an effective treatment method in RCC patients with advanced tumor IVC invasion. The method allows to achieve satisfactory long-term survival rates and functional results.
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Давыдов et al. (2017) conducted an observational in Renal cell carcinoma with advanced inferior vena cava tumor invasion (n=49). Nephrectomy, thrombectomy, and circular IVC resection was evaluated on 5-year overall survival. Nephrectomy with segmental or subtotal cavectomy in patients with renal cell carcinoma and massive inferior vena cava tumor invasion achieved a 5-year overall survival of 54.6%.
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