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The surgical management and prognosis of renal cell cancer with IVC tumor thrombus: 15-Years of experience using a multi-specialty approach at a single UK referral center

Lookup NU author(s): Dr Ased Ali, Professor John Dark, Professor Derek Manas, David Thomas

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Abstract

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 (1). 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. (C) 2013 Elsevier Inc. All rights reserved.

Publication metadata

Author(s): Ali ASM, Vasdev N, Shanmuganathan S, Paez E, Dark JH, Manas D, Thomas DJ

Publication type: Article

Publication status: Published

Journal: Urologic Oncology: Seminars and Original Investigations

Year: 2013

Volume: 31

Issue: 7

Pages: 1298-1304

Print publication date: 01/10/2013

Online publication date: 09/12/2011

ISSN (print): 1078-1439

ISSN (electronic): 1873-2496

Publisher: Elsevier

URL: http://dx.doi.org/10.1016/j.urolonc.2011.11.001

DOI: 10.1016/j.urolonc.2011.11.001

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