UNLABELLED: Renal cell carcinoma (RCC) propagates into the IVC in 4% of cases with 1% extending into the right atrium. Radical surgical resection remains the definitive curative/palliative treatment in those without significant metastases. The aim was to review our experience in patients with different levels of IVC involvement, cardiopulmonary bypass (CPB) and perioperative/long term outcomes. PATIENTS AND METHODS: From 2001 to 2012, 24 radical nephrectomies with IVC thrombectomy were performed. A retrospective chart review was undertaken to record demographics, presenting symptoms, duration of surgery, peri-operative transfusion, CPB and peri-operative complications, tumour grade/stage, and patient survival. RESULTS: We identified 24 patients (18 male, Age median 59 range 35-78). The commonest presenting symptoms were weight loss, pain and haematuria. The majority of tumours were right sided (n = 17) with 8 having lung metastases at presentation. Thrombus level was 16 (infradiaphragmatic), 2 (supradiaphragmatic), 6 (intra-atrial). 15 patients required sternotomy for vascular control and 9 required CPB both with a significantly longer operative time compared (6.1 ± 3.5 vs. 7.2 ± 1.2 vs. 3.5 ± 1.1 h, respectively). Peri-operative complications (n = 21) included cardiopulmonary, renal, gastrointestinal and septic problems. There were 2 peri-operative deaths. Blood transfusion was significantly less in those not requiring sternotomy or CPB using the "Cell Saver" device. The majority were Fuhrman grade 3 (n = 16) and clear cell type (n = 14). Overall 3-year survival was 100% (Laparotomy only), 40% (sternotomy + cross-clamp), and 20% (CPB). CONCLUSIONS: IVC thrombectomy has significant morbidity and requires careful patient selection and a multi-disciplinary approach to optimise patient outcomes. In this series, the level of IVC thrombus and requirement for CPB directly affects patient morbidity and outcome.
UNLABELLED: Renal cell carcinoma (RCC) propagates into the IVC in 4% of cases with 1% extending into the right atrium. Radical surgical resection remains the definitive curative/palliative treatment in those without significant metastases. The aim was to review our experience in patients with different levels of IVC involvement, cardiopulmonary bypass (CPB) and perioperative/long term outcomes. PATIENTS AND METHODS: From 2001 to 2012, 24 radical nephrectomies with IVC thrombectomy were performed. A retrospective chart review was undertaken to record demographics, presenting symptoms, duration of surgery, peri-operative transfusion, CPB and peri-operative complications, tumour grade/stage, and patient survival. RESULTS: We identified 24 patients (18 male, Age median 59 range 35-78). The commonest presenting symptoms were weight loss, pain and haematuria. The majority of tumours were right sided (n = 17) with 8 having lung metastases at presentation. Thrombus level was 16 (infradiaphragmatic), 2 (supradiaphragmatic), 6 (intra-atrial). 15 patients required sternotomy for vascular control and 9 required CPB both with a significantly longer operative time compared (6.1 ± 3.5 vs. 7.2 ± 1.2 vs. 3.5 ± 1.1 h, respectively). Peri-operative complications (n = 21) included cardiopulmonary, renal, gastrointestinal and septic problems. There were 2 peri-operative deaths. Blood transfusion was significantly less in those not requiring sternotomy or CPB using the "Cell Saver" device. The majority were Fuhrman grade 3 (n = 16) and clear cell type (n = 14). Overall 3-year survival was 100% (Laparotomy only), 40% (sternotomy + cross-clamp), and 20% (CPB). CONCLUSIONS: IVC thrombectomy has significant morbidity and requires careful patient selection and a multi-disciplinary approach to optimise patient outcomes. In this series, the level of IVC thrombus and requirement for CPB directly affects patient morbidity and outcome.
Authors: Juan I Martínez-Salamanca; Estefania Linares; Javier González; Roberto Bertini; Joaquín A Carballido; Thomas Chromecki; Gaetano Ciancio; Sia Daneshmand; Christopher P Evans; Paolo Gontero; Axel Haferkamp; Markus Hohenfellner; William C Huang; Theresa M Koppie; Viraj A Master; Rayan Matloob; James M McKiernan; Carrie M Mlynarczyk; Francesco Montorsi; Hao G Nguyen; Giacomo Novara; Sascha Pahernik; Juan Palou; Raj S Pruthi; Krishna Ramaswamy; Oscar Rodriguez Faba; Paul Russo; Shahrokh F Shariat; Martin Spahn; Carlo Terrone; Derya Tilki; Daniel Vergho; Eric M Wallen; Evanguelos Xylinas; Richard Zigeuner; John A Libertino Journal: Curr Urol Rep Date: 2014-05 Impact factor: 3.092
Authors: Christian Niedworok; Bettina Dörrenhaus; Frank Vom Dorp; Jarowit Adam Piotrowski; Stephan Tschirdewahn; Tibor Szarvas; Herbert Rübben; Marcus Schenck Journal: World J Urol Date: 2014-11-30 Impact factor: 4.226
Authors: Hao G Nguyen; Derya Tilki; Marc A Dall'Era; Blythe Durbin-Johnson; Joaquín A Carballido; Thenappan Chandrasekar; Thomas Chromecki; Gaetano Ciancio; Siamak Daneshmand; Paolo Gontero; Javier Gonzalez; Axel Haferkamp; Markus Hohenfellner; William C Huang; Estefania Linares Espinós; Philipp Mandel; Juan I Martinez-Salamanca; Viraj A Master; James M McKiernan; Francesco Montorsi; Giacomo Novara; Sascha Pahernik; Juan Palou; Raj S Pruthi; Oscar Rodriguez-Faba; Paul Russo; Douglas S Scherr; Shahrokh F Shariat; Martin Spahn; Carlo Terrone; Daniel Vergho; Eric M Wallen; Evanguelos Xylinas; Richard Zigeuner; John A Libertino; Christopher P Evans Journal: J Urol Date: 2015-03-19 Impact factor: 7.450