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Tathireddy H, Rice D, Martens K, Shivakumar S, Shatzel J. Breaking down tumor thrombus: Current strategies for medical management. Thromb Res 2023; 230:144-151. [PMID: 37722206 PMCID: PMC11027429 DOI: 10.1016/j.thromres.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/13/2023] [Accepted: 09/11/2023] [Indexed: 09/20/2023]
Abstract
Tumor thrombus, the intravascular extension of tumor into adjacent blood vessels, is frequently encountered in patients with renal cell carcinoma and hepatocellular carcinoma, and often involves the abdominal vasculature including the renal vein, portal vein, and the inferior vena cava. While a bland thrombus is composed of platelets and fibrin, in contrast, a tumor thrombus refers to an organized collection of tumor cells. Though oftentimes detected incidentally on imaging, tumor thrombus may have significant clinical implications and can be challenging to differentiate from bland thrombus. Additionally, the optimal management of tumor thrombus, including the use of anticoagulation, remains poorly described. This review summarizes common causes of tumor thrombus, as well as its impact on staging, prognosis, and treatment.
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Affiliation(s)
- Harsha Tathireddy
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
| | - Douglas Rice
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kylee Martens
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Joseph Shatzel
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, OR, USA
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2
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Li KP, Chen SY, Wang CY, Li XR, Yang L. Perioperative and oncologic outcomes of minimally-invasive surgery for renal cell carcinoma with venous tumor thrombus: a systematic review and meta-analysis of comparative trials. Int J Surg 2023; 109:2762-2773. [PMID: 37526108 PMCID: PMC10498880 DOI: 10.1097/js9.0000000000000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/06/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The present study aimed to conduct a pooled analysis to compare the perioperative and oncologic outcomes of minimally-invasive radical nephrectomy with tumor thrombus (MI-RNTT) with open radical nephrectomy with tumor thrombus (O-RNTT). METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Four electronic databases (PubMed, Embase, Web of Science, and the Cochrane Library database) were systematically searched to identify relevant studies published in English up to December 2022. The primary outcomes were perioperative results, complications, and oncologic outcomes. Review Manager 5.4 was used for this analysis. RESULTS In total, eight retrospective trials with a total of 563 patients were included. Compared to O-RNTT, MI-RNTT had shorter hospitalization time [weighted mean difference (WMD) -3.58 days, 95% CI: -4.56 to -2.59; P <0.00001), lower volumes of blood loss (WMD -663.32 ml, 95% CI: -822.22 to -504.42; P <0.00001), fewer transfusion rates (OR 0.18, 95% CI: 0.09-0.35; P <0.00001), fewer overall complications (OR 0.33, 95% CI: 0.22-0.49; P <0.00001), and fewer major complications s (OR 0.49, 95% CI: 0.24-1.00; P =0.05). However, operative time, intraoperative complications, mortality rate (intraoperative, within 30 days, and total mortality), overall survival, recurrence-free survival, and cancer-specific survival did not significantly differ between the two groups. CONCLUSIONS MI-RNTT possesses more benefits than O-RNTT in terms of length of hospital stay, blood loss, and complications and provides comparable mortality rates and oncologic outcomes. However, more comprehensive and rigorous research is warranted to further validate the outcomes, which should include a larger sample size and comprehensive data from high-volume medical centers.
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Affiliation(s)
| | | | | | - Xiao-ran Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, People’s Republic of China
| | - Li Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, People’s Republic of China
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Wei B, Zhou H, Liu G, Zheng Y, Zhang Y, Hao C, Wang Y, Kang H, Lu X, Yuan Y, Meng Q. Risk factors for venous thromboembolism in patients with spinal cord injury: A systematic review and meta-analysis. J Spinal Cord Med 2023; 46:181-193. [PMID: 33890837 PMCID: PMC9987783 DOI: 10.1080/10790268.2021.1913561] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Patients with spinal cord injury (SCI) are at high risk for venous thromboembolism (VTE). The risk factors for VTE in patients with SCI are complex. OBJECTIVE This meta-analysis was conducted to clarify the risk factors for VTE in patients with SCI. METHODS The Cochrane Library, PubMed, EBSCO, Web of Science, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Wanfang Med Data Database, and VIP Database were searched to identify studies reporting on risk factors for VTE in patients with SCI. RESULTS The meta-analysis included 25 studies. Findings showed that risk of VTE in patients with SCI was significantly associated with middle- and old-age (OR = 2.08, 95%CI, 1.47, 2.95), male sex (OR = 1.41, 95%CI, 1.26, 1.59), complete paralysis (OR = 3.69, 95%CI, 2.60, 5.24), personal/family history of venous thrombosis (OR = 1.95, 95%CI, 1.35, 2.81), history of smoking (OR = 2.67, 95%CI, 1.79, 3.98), lack of compression therapy (OR = 2.44, 95%CI, 1.59, 3.73), presence of lower limb/pelvic fracture (OR = 3.47, 95%CI, 1.79, 6.75), paraplegia (OR = 1.81, 95%CI, 1.49, 2.19), and diabetes (OR = 4.24, 95%CI, 2.75, 6.52). CONCLUSION The meta-analysis identified 9 risk factors for VTE in patients with SCI. Healthcare providers should be aware of the risk factors for VTE when rehabilitating patients with SCI.
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Affiliation(s)
- Bo Wei
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Hongjun Zhou
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Genlin Liu
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Ying Zheng
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Ying Zhang
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Chunxia Hao
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Yiji Wang
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Haiqiong Kang
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Xiaolei Lu
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Yuan Yuan
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Qianru Meng
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
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Handa A, Khanna R, Tendolkar MS, Singh S. Post-nephrectomy pulmonary thromboembolism. Med J Armed Forces India 2022; 78:489-491. [PMID: 36267509 PMCID: PMC9577313 DOI: 10.1016/j.mjafi.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/02/2021] [Indexed: 11/20/2022] Open
Abstract
The association of pulmonary thromboembolism with nephrectomy is well documented in malignant conditions. However, the data for incidence of pulmonary thromboembolism following nephrectomy in nonmalignant conditions remains scarce. We report the first case of an incidence of pulmonary thromboembolism following nephrectomy in a patient with a nonfunctional kidney due to multiple renal calculi.
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Affiliation(s)
- Ajay Handa
- Senior Consultant (Pulmonary Medicine), Sakra World Hospital, Bengaluru, India
| | - Rajesh Khanna
- Professor & Head (Urology), MMIMSR MM Medical College, Ambala, India
| | | | - Sarvinder Singh
- Consultant (Pulmonary Medicine), Army Hospital (R&R), New Delhi, India
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Caño Velasco J, Polanco Pujol L, Hernandez Cavieres J, González García F, Herranz Amo F, Ciancio G, Hernández Fernández C. Controversies in the diagnosis of renal cell carcinoma with tumor thrombus. Actas Urol Esp 2021; 45:257-263. [PMID: 33139067 DOI: 10.1016/j.acuro.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
Diagnosis and treatment of renal cell carcinoma with venous tumor thrombosis remains a challenge today, requiring multidisciplinary teams, mainly in tumor thrombus levels III-IV. Our objective is to present the various diagnostic techniques used and its controversies. A review of the most relevant related articles between January 2000 and August 2020 has been carried out in PubMed, EMBASE and Scielo. Continuous technological development has allowed progress in its detection, in the approximation of the histological subtype, and in the determination of tumor thrombus level. Regardless of the imaging technique used for its diagnosis (CT, MRI, TEE, ultrasound with contrast), the time elapsed until treatment is vitally important to reduce the risk of complications, some of them fatal, such as pulmonary thromboembolism.
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Jiang W, Cao C, Shi H, Shou J, Wang D, Wen L, Li C, Ma J. Pre-operative risk factors predicting missed diagnosis of renal vein tumor thrombus in renal cell carcinoma: a retrospective cohort study. Scand J Urol 2020; 54:128-134. [PMID: 32054374 DOI: 10.1080/21681805.2020.1727007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Previous reports showed that some patients with renal cell carcinoma (RCC) and renal vein tumor thrombus (RVTT) were misdiagnosed pre-operatively. To improve the accuracy of this diagnosis, the clinical characteristics of RCC with missed RVTT diagnosis were analyzed. METHODS We retrospectively reviewed RCC patients with RVTT between January 2000 and December 2015. The survival analysis was estimated using the Kaplan-Meier method. The Cox proportional hazard models were applied to identify risk factors. RESULTS The missed diagnosis rate of RVTT in RCC was 30.5%. In multivariate analysis, maximal tumor diameter, tumor located in the middle part, renal vein contrast agents filling insufficiently and tumor with collateral vessels (odds ratio = 1.22, 1.35, 1.25, 1.22; and p = .034, .003, .015 and .037, respectively) were independent predictors of missed RVTT diagnosis. A missed-diagnosis score was presented as area under curve of 0.852 (p < .001). Moreover, the missed diagnosis group had favorable prognosis, and tumor with collateral vessels was an independent prognostic indicator of poor overall survival time (hazard ratio = 1.15, p = .025). CONCLUSIONS This was the first study exploring clinical features as predictors of missed RVTT diagnosis. The possibility of complicating tumor thrombus should be considered when there is pre-operative presence of tumor with large diameter, renal tumor in the middle part, renal tumor with collateral vessels and renal vein contrast agents filling insufficiently. Patients with three points in missed-diagnosis scoring suggested a high possibility of missed RVTT diagnosis, and tumor with collateral vessels indicated poor prognosis.
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Affiliation(s)
- Weixing Jiang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chuanzhen Cao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongzhe Shi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Wang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Wen
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changling Li
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianhui Ma
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Rose KM, Navaratnam AK, Faraj KS, Abdul-Muhsin HM, Syal A, Elias L, Moss AA, Eversman WG, Stone WM, Money SR, Davila VJ, Tyson MD, Castle EP. Comparison of Open and Robot Assisted Radical Nephrectomy With Level I and II Inferior Vena Cava Tumor Thrombus: The Mayo Clinic Experience. Urology 2020; 136:152-157. [DOI: 10.1016/j.urology.2019.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/24/2019] [Accepted: 11/02/2019] [Indexed: 10/25/2022]
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8
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Rose KM, Navaratnam AK, Abdul-Muhsin HM, Faraj KS, Eversman SA, Moss AA, Eversman WG, Stone WM, Money SR, Davila VJ, Castle EP. Robot Assisted Surgery of the Vena Cava: Perioperative Outcomes, Technique, and Lessons Learned at The Mayo Clinic. J Endourol 2019; 33:1009-1016. [DOI: 10.1089/end.2019.0429] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Kyle M. Rose
- Department of Urology, Mayo Clinic Arizona, Phoenix, Arizona
| | | | | | - Kassem S. Faraj
- Department of Urology, Mayo Clinic Arizona, Phoenix, Arizona
| | | | - Adyr A. Moss
- Division of Transplant, Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | | | - William M. Stone
- Department of Vascular Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Samuel R. Money
- Department of Vascular Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Victor J. Davila
- Department of Vascular Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Erik P. Castle
- Department of Urology, Mayo Clinic Arizona, Phoenix, Arizona
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Prospective randomized comparative study on rivaroxaban and LMWH for prophylaxis of post-apheresis thrombosis in adoptive T cell immunotherapy cancer patients. J Thromb Thrombolysis 2019; 47:505-511. [PMID: 30903459 DOI: 10.1007/s11239-019-01844-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Autologous adoptive T cell immunotherapy has been recognized as an effective treatment for cancer patients. The initial qualified lymphocytes is the core element determining the immunotherapeutic outcomes clinically. Cell separator based apheresis procedure is an optimal procedure to collect adequate mono-nucleated lymphocytes to generate efficient ex vivo T cell expansions; however, potential catheter-associated femoral vein thrombosis at post-apheresis might rise an additional deteriorated morbidity for cancer patients. The emerging prophylactic medications are required at such circumstances. Therefore this study was designed to compare the prophylactic effects of rivaroxaban versus low molecular weight heparin (LMWH) in patients who had exposed during the femoral vein catheterization for apheresis. 74 Patients were randomized 1:1:1 into three groups: subcutaneous injection of LMWH, Fraxiparine (n = 23) (0.4 ml, 3800 IU/day) for 2 days, oral rivaroxaban 10 mg/d (n = 26), and oral rivaroxaban 20 mg/d (n = 25) for consecutive 2 days. The primary endpoint was to compare the venous thromboembolism (VTE) occurrence cases in one month post catheterization. There were 4 cases confirmed VTE occurrence in LMWH group with contrast to 1 case in rivaroxaban 10 mg administration group. None was seen in rivaroxaban 20 mg group (P = 0.02 as the comparison with LMWH). Meantime there was no bleeding events occurrence afterwards. Oral rivaroxaban 20 mg/day was recommendable to be considered which superior to LMWH. Although these limited data and patient volume reached the statistical difference which was able to provide the evidence proofed to compare the potency of those two anticoagulants, it could be regarded as the preliminary data provide the clinical results for cancer patients who were placed in the condition of apheresis and subsequently undergone adoptive T cell immunotherapy.Trial registration ClinicalTrials.gov identifier, NCT03282643. Registered 16 February 2016, http://www.ClinicalTrials.gov/ NCT03282643.
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Smith JA. This Month in Adult Urology. J Urol 2018. [DOI: 10.1016/j.juro.2018.05.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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