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Surgical management of renal cell carcinoma with inferior vena caval thrombus: a teaching hospital experience.

Abstract：

PURPOSE:To evaluate the outcome of patients of renal cell carcinoma (RCC) with inferior vena caval (IVC) thrombus treated by radical nephrectomy and IVC thrombectomy in terms of clinical and pathological factors and prognosis. MATERIALS AND METHODS:Sixty-three consecutive patients of RCC with IVC thrombus who underwent radical nephrectomy with IVC thrombectomy between June 1993 and May 2003 were included in this retrospective analysis. Data was analyzed in terms of clinical factors, such as level of thrombus and pathological factors, such as grade, local invasion and N status. RESULTS:Tumor thrombus level was infrahepatic in 35 patients, retrohepatic in 20 and suprahepatic in 8, including 5 with right atrial thrombus. The immediate post-operative mortality was 3% and the incidence of major post-operative complications was 34%, but most of them improved after conservative management except one who needed surgery for burst abdomen. The disease free survival (DFS) was 48.5%, 50.6%, 66.6% and 40% for infrahepatic, retrohepatic, suprahepatic and intra-atrial tumors, respectively. Of the histological types, patients with clear cell tumors had the best prognosis; those with granular cell had the worst prognosis (DFS of 53.5% vs 33.3%, though statistically not significant). Grade-2 tumors had better prognosis than grade-4 tumors (DFS 66.6% vs 0%, P < 0.001). Sixty-eight percent of patients without perinephric fat invasion were free of disease as compared to 31% of those with perinephric fat invasion (P < 0.01). Further, N status showed DFS of 60.9% in patients with negative nodes and 30% in patients with positive nodes (P < 0.05). CONCLUSION:Though surgery for RCC with IVC thrombus has high morbidity, it can give good results in terms of prolonged DFS in expert hands. Regarding long-term survival, pathological factors, such as local stage and grade, are more important than clinical factors, such as level of thrombus.

journal_name

Indian J Cancer

journal_title

Indian journal of cancer

authors

Kulkarni JN,Acharya PU,Rizvi SJ,Somaya AC

doi

10.4103/0019-509x.35810

subject

Has Abstract

pub_date

2007-04-01 00:00:00

pages

45-50

issue

eissn

0019-509X

issn

1998-4774

journal_volume

pub_type

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Surgical management of renal cell carcinoma with inferior vena caval thrombus: a teaching hospital experience.