January 1, 2017Open Access
View Full PaperSurgical Management and Outcome of Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus
Key Result
Radical nephrectomy and thrombectomy for renal cancer with inferior vena cava thrombus provided a 5-year overall survival of 43.7%, with tumor progression detected in 41.6% of patients.
Study Design
Type
Cohort (n=46)
Structured PICO
What are the long-term survival and progression outcomes following radical nephrectomy and thrombectomy in patients with renal cell carcinoma and IVC tumor thrombus?
P
Population
46 patients with renal cancer and inferior vena cava tumor thrombus who underwent radical nephrectomy and thrombectomy, followed for a mean of 3.6 years.
E
Exposure
Radical nephrectomy and thrombectomy performed in a single session (using cardiopulmonary bypass in 14 patients and deep hypothermic cardiac arrest in 4 cases).
O
Outcome
Overall survival and tumor progression (local recurrence and distant metastases).hard clinical
Radical nephrectomy and thrombectomy provide reasonable long-term survival (5-year OS 43.7%) for patients with renal cancer and IVC thrombus, though tumor progression remains common.
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.