Renal cell carcinoma with tumor thrombus growing against the direction of venous return: an indicator of complicated surgery and poor prognosis

• Published in: BMC surgery 2021-12, Vol.21 (1), p.443-443, Article 443
• Main Authors: Liu, Zhuo, Li, Yuxuan, Zhao, Xun, Ge, Liyuan, Zhu, Guodong, Hong, Peng, Tang, Shiying, Zhang, Shudong, Tian, Xiaojun, Wang, Shumin, Liu, Cheng, Zhang, Hongxian, Ma, Lulin
• Format: Article
• Language: English
• Subjects: Abdomen; Blood clot; Blood clots; Blood vessels; Carcinoma, Renal cell; Carcinoma, Renal Cell - surgery; Classification; Clinical medicine; Complexity; Complications; Creatinine; Dissection; Growing against the direction of venous return; Humans; Kidney cancer; Kidney Neoplasms - surgery; Lymph nodes; Lymphatic system; Medical prognosis; Metastases; Metastasis; Multivariate analysis; Nephrectomy; Normal distribution; Ovaries; Patients; Postoperative; Prognosis; Regression analysis; Renal cell carcinoma; Retrospective Studies; Risk analysis; Risk factors; Surgery; Survival; Thrombosis; Thrombosis - surgery; Tumor thrombus; Tumors; Veins; Veins & arteries; Vena Cava, Inferior - diagnostic imaging; Vena Cava, Inferior - surgery
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-021-01448-0

To explore the effect of tumor thrombus growing against the direction of venous return (GADVR) tumor thrombus on the choice of surgical approach, the impact on the complexity of the surgery and the prognosis. We retrospectively analyzed the clinicopathological data of 213 patients, who underwent surgery in a single center of Peking University Third Hospital between January 2016 and June 2020. For right renal cell carcinoma (RCC) and venous tumor thrombus (VTT), imaging revealed a filling defect in the left renal vein, which was significantly enhanced in enhanced imaging, suggesting that the tumor thrombus grew against the direction of venous return into the left renal vein. For left RCC and VTT, at least one of the left renal vein branches has tumor thrombus. The branches include the left adrenal vein, the left gonadal vein (testicular vein or ovarian vein), and the left ascending lumbar vein. The patients were divided into two groups according to whether they were GADVR tumor thrombus, and we compare the clinicopathological characteristics of GADVR tumor thrombus and non-GADVR tumor thrombus. Univariate and multivariate Cox regression analyses were performed to explore the risk factors that affect the prognosis of patients with RCC and VTT. Kaplan-Meier plots were conducted to evaluate the effect of GADVR on progression-free survival (PFS). Compared with non-GADVR tumor thrombus, patients with GADVR tumor thrombus had a higher proportion of open surgery (76.2% vs. 52.1%, P = 0.035), a higher proportion of tumor thrombus adhering to the inferior vena cava (IVC) vessel wall (81% vs. 45.8%, P = 0.002), a higher proportion of segmental resection of the IVC vessel wall (61.9% vs. 15.6%, P