Radical nephrectomy with vena caval thrombectomy: a contemporary experience

被引:53
作者
Kaag, Matthew G. [1 ]
Toyen, Christien [2 ]
Russo, Paul [1 ]
Cronin, Angel [3 ]
Thompson, R. Houston [1 ]
Schiff, Jeffrey [1 ]
Bernstein, Melanie [1 ]
Bains, Manjit [2 ]
机构
[1] Mem Sloan Kettering Canc Ctr, Dept Surg, Urol Serv, New York, NY 10065 USA
[2] Mem Sloan Kettering Canc Ctr, Dept Surg, Thorac Serv, New York, NY 10065 USA
[3] Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, New York, NY 10065 USA
关键词
RCC; kidney; vena cava; nephrectomy; RENAL-CELL CARCINOMA; SURGICAL-MANAGEMENT; TUMOR THROMBUS; VENOVENOUS BYPASS; INTERFERON-ALPHA; CANCER; COMPLICATIONS; RESECTION; SURGERY; CLASSIFICATION;
D O I
10.1111/j.1464-410X.2010.09661.x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE To report on the contemporary Memorial Sloan-Kettering Cancer Center experience with radical nephrectomy and vena caval thrombectomy. PATIENTS AND METHODS Patients who underwent radical nephrectomy and vena caval thrombectomy without the use of bypass techniques were retrospectively identified. Data were collected on intraoperative and pathological findings as well as postoperative complications and oncological outcomes. RESULTS In all, 78 patients underwent radical nephrectomy with off-bypass resection of vena caval thrombus between 1989 and 2009. The median (interquartile range, IQR) operation duration was 293 (226-370) min, and median (IQR) blood loss was 1300 (750-2500) mL. In all, 10 patients (13%) were confirmed to have intra- or supra-hepatic tumour thrombus (level 3/4), eight of whom required supra-hepatic control of the inferior vena cava (IVC). Major (grade 3-5) postoperative complications occurred in 14 (18%), with five postoperative deaths. Disease recurred in 27/62 patients who were considered completely resected at surgery and had adequate follow-up. The overall 5-year survival (95% confidence interval) probability was 48% (35-60%). CONCLUSIONS Radical nephrectomy with vena caval thrombectomy is associated with acceptable postoperative morbidity and mortality, and long-term survival is possible in some patients. Many level 3/4 thrombi could be safely approached without the use of bypass techniques.
引用
收藏
页码:1386 / 1393
页数:8
相关论文
共 50 条
[21]   Long-term Survival in Patients Undergoing Radical Nephrectomy and Inferior Vena Cava Thrombectomy: Single-Center Experience [J].
Ciancio, Gaetano ;
Manoharan, Murugesan ;
Katkoori, Devendar ;
De Los Santos, Rosely ;
Soloway, Mark S. .
EUROPEAN UROLOGY, 2010, 57 (04) :667-672
[22]   Impact of Hospital Case Volume on Outcomes Following Radical Nephrectomy and Inferior Vena Cava Thrombectomy [J].
Freifeld, Yuval ;
Woldu, Solomon L. ;
Singla, Nirmish ;
Clinton, Timothy ;
Bagrodia, Aditya ;
Hutchinson, Ryan ;
Lotan, Yair ;
Margulis, Vitaly .
EUROPEAN UROLOGY ONCOLOGY, 2019, 2 (06) :691-698
[23]   Feasibility of Pure Conventional Retroperitoneal Laparoscopic Radical Nephrectomy With Level II Vena Caval Tumor Thrombectomy [J].
Wang, Mingshuai ;
Zhang, Junhui ;
Niu, Yinong ;
Xing, Nianzeng .
UROLOGY, 2016, 90 :101-104
[24]   Metastatic renal cell carcinoma with concurrent inferior vena caval invasion: Long-term survival after combination therapy with radical nephrectomy, vena caval thrombectomy and postoperative immunotherapy [J].
Naitoh, J ;
Kaplan, A ;
Dorey, F ;
Figlin, R ;
Belldegrun, A .
JOURNAL OF UROLOGY, 1999, 162 (01) :46-50
[25]   Laparoscopic radical nephrectomy after shrinkage of a caval tumor thrombus with sunitinib [J].
Harshman, Lauren C. ;
Srinivas, Sandy ;
Kamaya, Aya ;
Chung, Benjamin I. .
NATURE REVIEWS UROLOGY, 2009, 6 (06) :338-343
[26]   Contemporary Experience with Laparoscopic Radical Nephrectomy [J].
Mues, Adam C. ;
Haramis, George ;
Rothberg, Michael B. ;
Okhunov, Zhamshid ;
Casazza, Cristin ;
Landman, Jaime .
JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES, 2011, 21 (01) :15-18
[27]   Laparoscopic Radical Nephrectomy and Inferior Vena Cava Thrombectomy in the Treatment of Renal Cell Carcinoma [J].
Shao, Pengfei ;
Li, Jie ;
Qin, Chao ;
Lv, Qiang ;
Ju, Xiaobing ;
Li, Pu ;
Shao, Yongfeng ;
Ni, Buqing ;
Yin, Changjun .
EUROPEAN UROLOGY, 2015, 68 (01) :115-122
[28]   Pure Conventional Laparoscopic Radical Nephrectomy with Level II Vena Cava Tumor Thrombectomy [J].
Wang, Mingshuai ;
Ping, Hao ;
Niu, Yinong ;
Zhang, Junhui ;
Xing, Nianzeng .
INTERNATIONAL BRAZ J UROL, 2014, 40 (02) :266-273
[29]   Radical robot-assisted laparoscopic nephrectomy with thrombectomy in the vena cava [J].
Estebanez Zarranz, J. ;
Belloso Loidi, J. ;
Gutierrez Garcia, M. A. ;
Rubio Calaveras, V ;
Morales Higelmo, G. ;
Melendo Tercilla, P. ;
Busto Leis, L. ;
Sanz Jaka, J. P. .
ACTAS UROLOGICAS ESPANOLAS, 2018, 42 (08) :538-541
[30]   A Decade of Robotic-Assisted Radical Nephrectomy with Inferior Vena Cava Thrombectomy: A Systematic Review and Meta-Analysis of Perioperative Outcomes [J].
Garg, Harshit ;
Psutka, Sarah P. ;
Hakimi, Abraham Ari ;
Kim, Hyung L. ;
Mansour, Ahmed M. ;
Pruthi, Deepak K. ;
Liss, Michael A. ;
Wang, Hanzhang ;
Gaspard, Christine S. ;
Ramamurthy, Chethan ;
Svatek, Robert S. ;
Kaushik, Dharam .
JOURNAL OF UROLOGY, 2022, 208 (03) :542-558