Long-term survival after surgical management of renal cell carcinoma with venous tumor thrombus
DOI:
https://doi.org/10.12775/JEHS.2020.10.12.024Keywords
renal cell carcinoma, inferior vena cava thrombus, radical nephrectomy, thrombectomy, long-term outcomesAbstract
The aim: to evaluate the long-term survival in patients after surgical management of renal cell carcinoma with venous tumor thrombus.
Materials and methods. From 1993 to 2019 88 patients with renal cell carcinoma, complicated by venous tumor thrombus, were observed at the Vascular surgery department of Lviv Regional Clinical Hospital: 65 (73.9%) men, 23 (26.1%) women, mean age – 58.7 ± 1.9 years. Surgical management included radical nephrectomy in combination with thrombectomy from inferior vena cava and right atrium. Kaplan-Meier method and log-rank test were used for survival analysis.
Results and discussion. Long-term survival was evaluated in 78 patients, the median follow-up was 51.6±14.3 months. Cumulative 2-, 5- and 10-year survival rates of patients with renal vein tumor thrombus (78.8%, 48.1%, 37.4%) were significantly higher compared to patients with intraatrial and inferior vena cava tumor thrombus (53.5%, 38.2%, 17.2%) (p<0.05). There was no significant difference in survival among patients with renal cell carcinoma, complicated with tumor venous thrombus, without and with metastases (p>0.05). Regarding to inferior vena cava tumor thrombus level there also was no significant difference in survival (p>0.05). As for the prognostic value of tumor histological gradation, the overall survival parameters were significantly higher in patients with G1-G2 compared with G3-G4 differentiation degrees of renal cell carcinoma (p<0.05).
Conclusions. Radical nephrectomy with thrombectomy from inferior vena cava and right atrium remains the only curative treatment for patients with renal cell carcinoma and venous tumor thrombus that allows to provide reasonable long-term survival outcomes.References
Ljungberg B, Albiges L, Bensalah K et al. EAU guidelines on renal cell carcinoma: 2020 update. https://uroweb.org/guidelines/
Ferlay J, Colombet M, Soerjomataram I et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer. 2018; 103: 356–387.
Bulletin of the National Cancer Registry of Ukraine №20 Kyiv 2018.
Hevia V, Ciancio G, Gómez V et al. Surgical technique for the treatment of renal cell carcinoma with inferior vena cava tumor thrombus: tips, tricks and oncological results. Springerplus. 2016; 5:132
Haidar GM, Hicks TD, El-Sayed HF et al. Treatment options and outcomes for caval thrombectomy and resection for renal cell carcinoma. J Vasc Surg Venous Lymphat Disord. 2017; 5(3): 430–436.
Martínez-Salamanca JI, Huang WC, Millan I et al. Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension. Eur Urol 2011;59(1):120– 127.
Gaudino M, Lau C, Cammertoni F et al. Surgical treatment of renal cell carcinoma with cavoatrial involvement: a systematic review of the literature. Ann Thorac Surg. 2016; 101(3): 1213–21.
Nini A, Capitanio U, Larcher A et al. Perioperative and oncologic outcomes of nephrectomy and caval thrombectomy using extracorporeal circulation and deep hypothermic circulatory arrest for renal cell carcinoma invading the supradiaphragmatic inferior vena cava and/or right atrium. Eur Urol. 2018; 73(5): 793–799.
Gagné-Loranger M, Lacombe L, Pouliot F et al. Renal cell carcinoma with thrombus extending to the hepatic veins or right atrium: operative strategies based on 41 consecutive patients. Eur J Cardiothorac Surg. 2016; 50(2): 317–21.
Lenis AT, Burton CS, Golla V et al. Cytoreductive nephrectomy in patients with metastatic renal cell carcinoma and venous thrombus – Trends and effect on overall survival. Urol Oncol. 2019.
Davydov MI, Matveev VB, Dzemeshkevich SL et al. Surgical treatment of renal cell carcinoma with tumor venous thrombosis in patients without distant metastases. Clin. Experiment. Surg. Petrovsky J. 2015; 4: 18 – 27.
Miyake H, Sugiyama T, Aki R et al. Oncological outcomes after cytoreductive nephrectomy for patients with metastatic renal cell carcinoma with inferior vena caval tumor thrombus. Int J Clin Oncol. 2018; 23(3): 553–558.
Vergho DC, Loeser A, Kocot A et al. Tumor thrombus of inferior vena cava in patients with renal cell carcinoma – clinical and oncological outcome of 50 patients after surgery. BMC Res Notes. 2012; 5: 5.
Ciancio G, Manoharan M, Katkoori D et al. Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: single-center experience. Eur Urol. 2010; 57(4): 667–72.
Wagner B, Patard JJ, Méjean A et al. Prognostic value of renal vein and inferior vena cava involvement in renal cell carcinoma. Eur Urol. 2009; 55(2): 452–9.
Pouliot F, Shuch B, LaRochelle JC et al. Contemporary management of renal tumors with venous tumor thrombus. The Journal of urology 2010, 184(3), 833–841.
Haddad AQ, Wood CG, Abel EJ et al. Oncologic outcomes following surgical resection of renal cell carcinoma with inferior vena caval thrombus extending above the hepatic veins: a contemporary multicenter cohort. J Urol. 2014; 192(4): 1050–6.
Tilki D, Hu B, Nguyen HG et al. Impact of synchronous metastasis distribution on cancer specific survival in renal cell carcinoma after radical nephrectomy with tumor thrombectomy. J Urol. 2015; 193(2): 436–42.
Rodriguez Faba O, Linares E, Tilki D et al. Impact of microscopic wall invasion of the renal vein or inferior vena cava on cancer specific survival in patients with renal cell carcinoma and tumor thrombus: a multi-institutional analysis from the international renal cell carcinoma-venous thrombus consortium. Eur Urol Focus. 2018; 4(3): 435–441.
Downloads
Published
How to Cite
Issue
Section
License
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 258
Number of citations: 0
