Nephrectomy and vena caval thrombectomy in patients with metastatic renal cell carcinoma

• Published in: Urology (Ridgewood, N.J.) N.J.), 1997-11, Vol.50 (5), p.673-677
• Main Authors: Slaton, Joel W., Derya Balbay, M., Levy, David A., Pisters, Louis L., Nesbitt, Jonathan C., Swanson, David A., Dinney, Colin P.N.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - secondary; Carcinoma, Renal Cell - surgery; Female; Humans; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Kidneys; Male; Medical sciences; Middle Aged; Neoplastic Cells, Circulating; Nephrectomy; Nephrology. Urinary tract diseases; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival Rate; Tumors of the urinary system; Vena Cava, Inferior
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(97)00329-4

Abstract To report our experience with performing nephrectomy and vena caval thombectomy in patients with metastatic renal cell carcinoma. A retrospective review was performed of 15 patients who underwent surgical excision of the primary tumor and a caval thrombus and treatment of concurrent metastases between 1989 and 1995. The sites of metastases included lungs (n = 8), bone (n = 3), bulky retroperitoneal or mediastinal lymph nodes (n = 2), liver (n = 1), and contralateral adrenal (n = 1). The level of caval involvement was suprahepatic in 3 cases, retrohepatic in 2 cases, and infrahepatic in 10 cases. Three patients had an Eastern Cooperative Oncology Group performance score of 0, 11 had a score of 1, and 1 had a score of 2. Median follow-up was 17 months. Median operative time was 6.5 hours and median hospitalization was 10 days. Two patients required re-exploration for postoperative hemorrhage. There were no perioperative deaths. Four patients underwent surgery for resection of solitary metastases (1 lung, 2 spine, and 1 humerus); 2 of the 4 received adjuvant radiotherapy. Two patients received biologic therapy preoperatively, 3 received it both preoperatively and postoperatively, and 6 received it only postoperatively. The median time to initiation of postoperative biologic therapy was 48 days (range 25 to 110). Eleven patients are currently alive, 7 with no evidence of disease at a median follow-up of 17 months (range 6 to 66) and 4 with stable metastases at 14 months (range 4 to 22). Ten of the 13 symptomatic patients had improved performance scores after surgery. Four patients have died from metastatic disease: 2 from rapid progression at 2 and 5 months after surgery and the other 2 at 17 and 42 months. Nephrectomy and vena caval thrombectomy can be safely performed in selected patients with metastatic disease. Furthermore, in patients receiving biologic therapy, nephrectomy may enable a better quality of life and prolonged survival.