Multi-disciplinary Surgical Approach to the Management of Patients with Renal Cell Carcinoma with Venous Tumor Thrombus: 15 year Experience and Lessons Learned

Overview

Journal BMC Urol

Publisher Biomed Central

Specialty Urology

Date 2016 Jul 21

PMID 27435269

Citations 10

Authors

Bishoy A Gayed

Ramy Youssef

Oussama Darwish

Payal Kapur

Aditya Bagrodia

James Brugarolas

Ganesh Raj

J Michael DiMaio

Arthur Sagalowsky

Vitaly Margulis

Affiliations

Soon will be listed here.

Abstract

Background: The management of patients with renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is challenging. We report our 15 year experience in the management of patients with RCC with VTT utilizing a multidisciplinary team approach, highlighting improved total and specifically Clavien III-V complication rates.

Methods: We reviewed the records of 146 consecutive patients who underwent radical nephrectomy with venous thrombectomy between 1998 and 2012. Data on patient history, staging, surgical techniques, morbidity, and survival were analyzed. Additionally, complication rates between two surgical eras, 1998-2006 and 2006-2012, were assessed.

Results: The study included 146 patients, 97 males (66 %), and a median age of 61 years (range, 24-83). Overall complications rate was 53 %, high grade complications (Clavien III -V) occurred in 10 % of patients. Most importantly, there was a lower incidence of overall and high grade complications (45 % and 8 %, respectively) in the last 6 years compared to the earlier surgeries included in the study (67 % and 13 % respectively) [p = .008 and .03, respectively). 30 day postoperative mortality was 2.7 %. 5 year overall survival (5Y- OS) and 5 year cancer specific survival (5Y- CSS) were 51 % and 40 %, respectively. Metastasis was the only independent predictor factor for CSS (HR 3.8, CI 1.9-7.6 and p < .001) and OS (HR 2.6, CI 1.5-4.7 and p = .001) in all patients.

Conclusions: Our data suggest that patients with RCC and VTT can be treated safely utilizing a multidisciplinary team approach leading to a decrease in complication rates.

Citing Articles

Risk factors for renal insufficiency and survival implications after radical nephrectomy and thrombectomy in renal cell carcinoma with tumor thrombus: a systematic review.

Huang Z, Liu Z, Zhuo L, Ma X, Jiang Z, Chen K BMC Urol. 2025; 25(1):20.

PMID: 39891097 PMC: 11783759. DOI: 10.1186/s12894-024-01664-9.

A Narrative Review on Robotic Surgery as Treatment for Renal Cell Carcinoma with Inferior Vena Cava Thrombus.

Shah M, Wang K, Shah Y, Ragam R, Simhal R, Ghodoussipour S J Clin Med. 2024; 13(5).

PMID: 38592152 PMC: 10932232. DOI: 10.3390/jcm13051308.

The value of enhanced multiparameteric MRI diagnostic model for preoperatively predicting surgical methods of inferior vena cava in patients with renal tumors and inferior vena cava tumor thrombus.

Pei X, Lu M, Liu Z, Liu B, Deng Y, Yuan H BMC Med Imaging. 2023; 23(1):86.

PMID: 37355601 PMC: 10290788. DOI: 10.1186/s12880-023-01043-0.

Predictors of Survival in Patients Undergoing Surgery for Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus.

Pieretti A, Ozambela M, Westerman M, Nogueras-Gonzalez G, Segarra L, Zacharias N Clin Genitourin Cancer. 2022; 20(4):e330-e338.

PMID: 35279419 PMC: 9486579. DOI: 10.1016/j.clgc.2022.02.001.

Extracorporeal Partial Nephrectomy with Orthotopic Autotransplantation under Pharmaco-Cold Ischaemia for Cancer of a Single Kidney: A Case Report.

Baitman T, Miroshkina I, Gritskevich A, Teplov A, Zotikov A, Kochetov A Case Rep Oncol. 2020; 13(3):1202-1208.

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