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CC BY-NC-ND 4.0 · Revista Urología Colombiana / Colombian Urology Journal 2022; 31(03): e109-e115
DOI: 10.1055/s-0042-1748871
Original Article/Artículo Original

Radical Nephrectomy in Renal Cell Carcinoma with Venous Tumoral Thrombus: Long-term Outcomes and Overall Survival

Nefrectomía radical en carcinoma de células renales con trombo tumoral venoso: Desenlaces a largo plazo y supervivencia global
Aysa Vanessa Mosquera 
1   Department of Urology, Hospital Militar Central, Bogotá DC, Colombia and Universidad Militar Nueva Granada School of Medicine, Urology Residency Program, Bogotá DC, Colombia
,
Catalina Barco-Castillo 
1   Department of Urology, Hospital Militar Central, Bogotá DC, Colombia and Universidad Militar Nueva Granada School of Medicine, Urology Residency Program, Bogotá DC, Colombia
,
Diego Camacho
2   Universidad Nacional School of Medicine, Bogotá DC, Colombia
3   Department of Urology, Fundación Clínica Shaio, Bogotá DC, Colombia
,
José Correa
4   Universidad del Rosario School of Medicine, Bogotá DC, Colombia
,
Rodolfo Varela
2   Universidad Nacional School of Medicine, Bogotá DC, Colombia
3   Department of Urology, Fundación Clínica Shaio, Bogotá DC, Colombia
5   Facultad de Medicina, Universidad Nacional de Colombia, Bogotá DC, Colombia
,
Danilo Citarella
1   Department of Urology, Hospital Militar Central, Bogotá DC, Colombia and Universidad Militar Nueva Granada School of Medicine, Urology Residency Program, Bogotá DC, Colombia
6   Department of Urology, Fundación Clínica Shaio, Bogotá DC, Colombia
,
Marino Cabrera
2   Universidad Nacional School of Medicine, Bogotá DC, Colombia
3   Department of Urology, Fundación Clínica Shaio, Bogotá DC, Colombia
6   Department of Urology, Fundación Clínica Shaio, Bogotá DC, Colombia
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Abstract

Objective To describe the five-year overall survival (OS) and perioperative morbidity of patients with renal cell carcinoma (RCC) with venous tumor thrombus (VTT) treated through radical nephrectomy and thrombectomy.

Materials and Methods We evaluated a cohort of 530 patients with a diagnosis of RCC from January 2009 to December 2019, and found VTT in 42 of them; these 42 patients composed the study sample. The patients were stratified according to the Neves Thrombus Classification (NTC). The baseline and perioperative characteristics, as well as the follow-up, were described. The Kaplan-Meier curve and its respective Cox regression were applied to present the 5-year OS and the OS stratified by the NTC.

Results The average age of the sample was of 63.19 ± 10.7 years, and there were no differences regarding gender. In total, VTT was present in 7.9% of the patients. According to the NTC, 30.9% of the cases corresponded to level I, 21.4%, to level II, 26.1%, to level III, and 21.4%, to level IV. The 5-year OS was of 88%. For level-I and level-II patients, the 5-year OS was of 100%, and of only 38% among level-IV patients. Complications, mostly minor, occurred in 57% of the cases.

Conclusions Radical nephrectomy with thrombectomy is a morbid procedure; however, most complications are minor, and the five-year mortality is null for patients in NTC levels I and II, and low for levels III and IV, and it may be even lower in level-III patients when standardizing transesophageal echocardiogram intraoperatively and routinary extracorporeal bypass. Thus, we recommend considering this surgery as the first-line management in patients with RCC and VTT.

Resumen

Objetivo Describir la supervivencia global (SG) a los cinco años y la morbilidad perioperatoria de pacientes con carcinoma de células renales (CCR) con trombo tumoral venoso (TTV) tratados por nefrectomía radical y trombectomía.

Materiales y Métodos Se evaluó una cohorte de 530 pacientes con diagnóstico de CCR entre enero de 2009 y diciembre de 2019, y se encontró TTV en 42 de ellos; esos 42 pacientes compusieron la muestra de este estudio. Los pacientes fueron estratificados según la clasificación de trombos de Neves (CTN). Se describieron las características basales y perioperatorias de los pacientes, así como el seguimiento. Se aplicaron la curva de Kaplan-Meier y su respectiva regresión de COX para presentar la SG a los 5 años y la SG estratificada por CTN.

Resultados La edad promedio de la muestra fue de 63,19 ± 10,7 años, sin diferencia respecto a género. El TTV estuvo presente en el 7,9% de los pacientes. Según la CTN, el 30,9% de los casos correspondía al nivel I, el 21,4%, al nivel II, el 26,1%, al nivel III, y el 21,4%, al nivel IV. La SG a los 5 años fue del 88%. Para los niveles I y II, la SG a los 5 años fue del 100%, y, para el nivel IV del 38%. Las complicaciones, menores en su mayoría, ocurrieron en el 57% de los casos.

Conclusiones La nefrectomía radical con trombectomía es un procedimiento mórbido; sin embargo, la mayoría de las complicaciones son menores, y la mortalidad a los 5 años es nula cuando en los pacientes de niveles I y II en la CYN, y baja en los niveles III y IV, y puede ser incluso menor en los pacientes de nivel III al estandarizar el ecocardiograma transesofágico intraoperatorio y el baipás extracorpóreo rutinario. Por ello, recomendamos considerar esta cirugía como manejo de primera línea en pacientes con CCR y TTV.

Keywords

renal cell carcinoma - venous tumor thrombus - Neves thrombus classification - survival analysis

Palabras clave

carcinoma de células renales - trombo tumoral venoso - clasificación de trombos de Neves - análisis de supervivencia


Publication History

Received: 10 July 2021

Accepted: 28 March 2022

Article published online:
28 September 2022

© 2022. Sociedad Colombiana de Urología. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424
    CrossrefPubMedGoogle Scholar
  • 2 Steven C Campbell, Brian R Lane, Phillip M Pierorazio. Malignant Renal Tumors. In: Campbell-Walsh-Wein Urology. 12th ed. 2020. p. 2133–2184.e15.
    CrossrefGoogle Scholar
  • 3 Ljungberg B, Stenling R, Osterdahl B, Farrelly E, Aberg T, Roos G. Vein invasion in renal cell carcinoma: impact on metastatic behavior and survival. J Urol 1995; 154 (05) 1681-1684
    CrossrefPubMedGoogle Scholar
  • 4 Neves RJ, Zincke H. Surgical treatment of renal cancer with vena cava extension. Br J Urol 1987; 59 (05) 390-395
    CrossrefPubMedGoogle Scholar
  • 5 Lambert EH, Pierorazio PM, Shabsigh A, Olsson CA, Benson MC, McKiernan JM. Prognostic risk stratification and clinical outcomes in patients undergoing surgical treatment for renal cell carcinoma with vascular tumor thrombus. Urology 2007; 69 (06) 1054-1058
    CrossrefPubMedGoogle Scholar
  • 6 Reese AC, Whitson JM, Meng MV. Natural history of untreated renal cell carcinoma with venous tumor thrombus. Urol Oncol 2013; 31 (07) 1305-1309
    CrossrefPubMedGoogle Scholar
  • 7 Toren P, Abouassaly R, Timilshina N, Kulkarni G, Alibhai S, Finelli A. Results of a national population-based study of outcomes of surgery for renal tumors associated with inferior vena cava thrombus. Urology 2013; 82 (03) 572-577
    CrossrefPubMedGoogle Scholar
  • 8 Ciancio G, Manoharan M, Katkoori D, De Los Santos R, Soloway MS. Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: single-center experience. Eur Urol 2010; 57 (04) 667-672
    CrossrefPubMedGoogle Scholar
  • 9 Wagner B, Patard J-J, Méjean A. et al. Prognostic value of renal vein and inferior vena cava involvement in renal cell carcinoma. Eur Urol 2009; 55 (02) 452-459
    CrossrefPubMedGoogle Scholar
  • 10 Zhang Q, Ma R, Liu Z, Zhang S, Ma L. A Contemporary High-Volume Center Analysis of Postoperative Complications Following Surgical Management of Renal Cell Carcinoma with Tumor Thrombus. Urol Int 2019; 102 (04) 427-434
    CrossrefPubMedGoogle Scholar
  • 11 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 (05) 793-799
    CrossrefPubMedGoogle Scholar
  • 12 Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int 2004; 94 (01) 33-41
    CrossrefPubMedGoogle Scholar
  • 13 Gu L, Ma X, Gao Y. et al. Robotic versus Open Level I-II Inferior Vena Cava Thrombectomy: A Matched Group Comparative Analysis. J Urol 2017; 198 (06) 1241-1246
    CrossrefPubMedGoogle Scholar
  • 14 Gill IS, Metcalfe C, Abreu A. et al. Robotic Level III Inferior Vena Cava Tumor Thrombectomy: Initial Series. J Urol 2015; 194 (04) 929-938
    CrossrefPubMedGoogle Scholar
  • 15 Chopra S, Simone G, Metcalfe C. et al. Robot-assisted Level II-III Inferior Vena Cava Tumor Thrombectomy: Step-by-Step Technique and 1-Year Outcomes. Eur Urol 2017; 72 (02) 267-274
    CrossrefPubMedGoogle Scholar