OBJECTIVES: Surgical management of renal cell carcinoma (RCC) invading the inferior vena cava (IVC) remains a technical challenge. However, radical surgery is the only potentially curative treatment. We set out to review our experience of using a multi-specialty approach to these patients over the last 15 years. PATIENTS AND METHODS: Fifty patients with RCC and IVC invasion underwent surgery at our institution (mean age: 59 years). Tumor thrombus was infrahepatic/levels I and II: n = 24, intrahepatic/level III: N = 14, or suprahepatic/level IV: n = 12. Infra- and intrahepatic caval tumors were resected using an abdominal approach and liver transplant techniques without cardiopulmonary bypass (CPB). CPB was used only with level IV thrombus. RESULTS: There were no intraoperative deaths. Median operating time was 6 hours and blood loss 3.5 liters (l). Staging was T3b: n = 34, T3c: n = 10 and T4: n = 6. Median time spent in HDU and hospital were 2 and 12.5 days, respectively. Perioperative mortality was 4%. Metastatic disease (P < 0.001) and level IV thrombus (P < 0.05) were significant negative prognostic factors. Forty of the 50 patients did not have metastasis. With mean follow-up of 38 months, the non-metastatic group had 2-year estimated Kaplan-Meier survival of 82.0% falling to 62.4% at 5 years. Conversely, in the metastatic group, estimated 2-year survival was 26.6% falling to 0% by 5 years. CONCLUSION: Surgical treatment of RCC involving the IVC is possible with acceptable morbidity and mortality. Long-term survival can be expected in over 60% of non-metastatic patients at 5 years. These cases benefit from a multidisciplinary surgical approach. Level III thrombus can be successfully managed without CPB.
OBJECTIVES: Surgical management of renal cell carcinoma (RCC) invading the inferior vena cava (IVC) remains a technical challenge. However, radical surgery is the only potentially curative treatment. We set out to review our experience of using a multi-specialty approach to these patients over the last 15 years. PATIENTS AND METHODS: Fifty patients with RCC and IVC invasion underwent surgery at our institution (mean age: 59 years). Tumor thrombus was infrahepatic/levels I and II: n = 24, intrahepatic/level III: N = 14, or suprahepatic/level IV: n = 12. Infra- and intrahepatic caval tumors were resected using an abdominal approach and liver transplant techniques without cardiopulmonary bypass (CPB). CPB was used only with level IV thrombus. RESULTS: There were no intraoperative deaths. Median operating time was 6 hours and blood loss 3.5 liters (l). Staging was T3b: n = 34, T3c: n = 10 and T4: n = 6. Median time spent in HDU and hospital were 2 and 12.5 days, respectively. Perioperative mortality was 4%. Metastatic disease (P < 0.001) and level IV thrombus (P < 0.05) were significant negative prognostic factors. Forty of the 50 patients did not have metastasis. With mean follow-up of 38 months, the non-metastatic group had 2-year estimated Kaplan-Meier survival of 82.0% falling to 62.4% at 5 years. Conversely, in the metastatic group, estimated 2-year survival was 26.6% falling to 0% by 5 years. CONCLUSION: Surgical treatment of RCC involving the IVC is possible with acceptable morbidity and mortality. Long-term survival can be expected in over 60% of non-metastatic patients at 5 years. These cases benefit from a multidisciplinary surgical approach. Level III thrombus can be successfully managed without CPB.
Authors: Neel A Mansukhani; George E Havelka; Irene B Helenowski; Heron E Rodriguez; Andrew W Hoel; Mark K Eskandari Journal: Surgery Date: 2016-12-20 Impact factor: 3.982
Authors: Laura Prakash; Jeffrey E Lee; James Yao; Priya Bhosale; Aparna Balachandran; Huamin Wang; Jason B Fleming; Matthew H G Katz Journal: J Gastrointest Surg Date: 2015-08-18 Impact factor: 3.452
Authors: Ross M Simon; Timothy Kim; Patrick Espiritu; Tony Kurian; Wade J Sexton; Julio M Pow-Sang; Einar Sverrisson; Philippe E Spiess Journal: Int Braz J Urol Date: 2015 Sep-Oct Impact factor: 1.541