Renal cell carcinoma with inferior vena caval tumour thrombus: Surgical management and clinical outcomes at a low-volume centre

• Published in: Surgical practice 2013-02, Vol.17 (1), p.2-6
• Main Authors: Cheung, Man-Hung, Ho, Kwan-Lun, Chan, See-Ching, Ho, Ka-Lai, Tam, Po-Chor, Yiu, Ming-Kwong, Au, Timmy W.K.
• Format: Article
• Language: English
• Subjects: Cancer; Clinical outcomes; inferior vena caval thrombus; Kidneys; renal cell carcinoma; Surgery; surgical management
• ISSN: 1744-1625; 1744-1633
• DOI: 10.1111/j.1744-1633.2012.00625.x

Aim In the present study, we discuss the surgical management, complications and clinical outcomes of patients with renal cell carcinoma (RCC) extending into the inferior vena cava (IVC), who were treated with surgical resection at a teaching hospital from 1997 to 2011. Patients and Methods Twelve patients diagnosed with RCC and IVC tumour thrombus underwent radical nephrectomy and IVC tumour thrombectomy during the study period. Results Of the 12 patients (male : female: 1:1), the mean age was 65 years (range: 48–82 years). All had good premorbid performance status and no distant metastasis at the time of operation. Employing the Mayo Clinic classification, the tumour thrombus extension was level I in four cases (33 per cent), level II in four cases (33 per cent), level III in two cases (17 per cent) and level IV in two cases (17 per cent). In one patient, the renal tumour extended into the right atrium and had a solitary right pulmonary artery tumour embolus, which subsequently underwent a simultaneous right pulmonary artery tumour embolectomy. In our series, the mean blood loss in levels I–IV tumour thrombus were 1050 mL, 2075 mL, 4152 mL and 11 500 mL, respectively. Complications occurred in three cases (25 per cent), and one (8.3 per cent) required re‐laparotomy for haemostasis. There was no hospital mortality. The median follow up was 45.5 months (range: 6–125 months). Median disease‐free and overall survivals were 29 and 76 months, respectively. Five‐year disease‐free and overall survivals were 35.5 per cent and 62.5 per cent, respectively. Conclusion Radical nephrectomy and IVC tumour thrombectomy remain a challenging procedure. With detailed perioperative planning and multidisciplinary efforts, surgical resection is the definitive treatment of choice for patients with RCC and IVC tumour thrombus. The perioperative and survival outcomes of the present series were comparable to contemporary series.