1
|
Zalay O, Mehra P, Pereira I, Malone J, Malone S. A review of stereotactic ablative radiotherapy for nonmetastatic renal cell carcinoma. World J Urol 2024; 42:52. [PMID: 38244135 DOI: 10.1007/s00345-023-04731-2] [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: 07/28/2023] [Accepted: 10/30/2023] [Indexed: 01/22/2024] Open
Abstract
Renal cell carcinoma (RCC) is an uncommon malignancy whose incidence has been increasing over the past few decades, posing treatment challenges for elderly or infirm patients who are not surgical candidates. Stereotactic ablative radiotherapy (SABR) has emerged as a promising non-invasive treatment modality for RCC. The high dose-per-fraction used in SABR overcomes some of the mechanisms of radioresistance that has hindered the effective treatment of RCC with conventional radiotherapy. For primary RCC, local control rates for SABR exceed 90%, with typically minimal grade 3 or higher toxicities, offering a viable alternative for inoperable patients and those not eligible for or unable to tolerate radiofrequency or cryotherapy ablation. SABR can also be used in patients with a solitary kidney as a strategy for renal preservation to avoid need for dialysis. Given its excellent local control rates, low toxicity and preservation of renal function, SABR offers an attractive alternative to more invasive modalities for treatment of localized RCC.
Collapse
Affiliation(s)
- Osbert Zalay
- Radiation Oncology, Kingston Health Science Centre, Kingston, Canada
| | - Prateek Mehra
- Ottawa Hospital Cancer Centre, Ottawa Hospital Regional Cancer Program, Ottawa, Canada
| | - Ian Pereira
- Radiation Oncology, Kingston Health Science Centre, Kingston, Canada
- Ottawa Hospital Cancer Centre, Ottawa Hospital Regional Cancer Program, Ottawa, Canada
| | - Julia Malone
- Ottawa Hospital Cancer Centre, Ottawa Hospital Regional Cancer Program, Ottawa, Canada
| | - Shawn Malone
- Ottawa Hospital Cancer Centre, Ottawa Hospital Regional Cancer Program, Ottawa, Canada.
| |
Collapse
|
2
|
Tariq A, McGeorge S, Pearce A, Rhee H, Wood S, Kyle S, Marsh P, Raveenthiran S, Wong D, McBean R, Westera J, Dunglison N, Esler R, Navaratnam A, Yaxley J, Thomas P, Pattison DA, Roberts MJ. Characterization of tumor thrombus in renal cell carcinoma with prostate specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT). Urol Oncol 2022; 40:276.e1-276.e9. [DOI: 10.1016/j.urolonc.2022.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/06/2022] [Accepted: 03/12/2022] [Indexed: 02/04/2023]
|
3
|
Complementary roles of surgery and systemic treatment in clear cell renal cell carcinoma. Nat Rev Urol 2022; 19:391-418. [PMID: 35546184 DOI: 10.1038/s41585-022-00592-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 12/12/2022]
Abstract
Standard-of-care management of renal cell carcinoma (RCC) indisputably relies on surgery for low-risk localized tumours and systemic treatment for poor-prognosis metastatic disease, but a grey area remains, encompassing high-risk localized tumours and patients with metastatic disease with a good-to-intermediate prognosis. Over the past few years, results of major practice-changing trials for the management of metastatic RCC have completely transformed the therapeutic options for this disease. Treatments targeting vascular endothelial growth factor (VEGF) have been the mainstay of therapy for metastatic RCC in the past decade, but the advent of immune checkpoint inhibitors has revolutionized the therapeutic landscape in the metastatic setting. Results from several pivotal trials have shown a substantial benefit from the combination of VEGF-directed therapy and immune checkpoint inhibition, raising new hopes for the treatment of high-risk localized RCC. The potential of these therapeutics to facilitate the surgical extirpation of the tumour in the neoadjuvant setting or to improve disease-free survival in the adjuvant setting has been investigated. The role of surgery for metastatic RCC has been redefined, with results of large trials bringing into question the paradigm of upfront cytoreductive nephrectomy, inherited from the era of cytokine therapy, when initial extirpation of the primary tumour did show clinical benefits. The potential benefits and risks of deferred surgery for residual primary tumours or metastases after partial response to checkpoint inhibitor treatment are also gaining interest, considering the long-lasting effects of these new drugs, which encourages the complete removal of residual masses.
Collapse
|
4
|
Şahan A, Özkaptan O, Çubuk A, Kösemen M, Kara Ö, Akça O. Laparoscopic radical nephrectomy with inferior vena cava thrombectomy. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
5
|
Kakoti S, Jena R, Sureka SK, Srivastava A, Mandhani A, Singh UP. Experience with management of renal cell carcinoma with inferior vena cava/right atrial tumor thrombus. Indian J Urol 2021; 37:234-240. [PMID: 34465952 PMCID: PMC8388349 DOI: 10.4103/iju.iju_13_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/04/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: We aimed to present our experience in managing renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus. Methods: Records of all patients aged 18 years and older, with a diagnosis of primary renal masses with IVC thrombus, presenting to our institute from January 2012 to August 2020 were retrospectively reviewed. Patients with tumor thrombus limited only to renal vein were excluded from the analysis. Their hospital course and outcomes were recorded and evaluated for predictors of survival. Results: During the study period, we treated 61 patients with a renal mass and concurrent IVC thrombus and 56 of these underwent surgery. 7 of them had level III and 6 had level IV thrombus. A total of six patients received neoadjuvant tyrosine kinase inhibitor (TKI) therapy and all of them showed a decrease in size and level of tumor thrombus and cardiopulmonary bypass was safely avoided. Fourteen patients had distant metastasis and underwent cytoreductive surgery and of these 12 patients received TKI therapy after surgery with a mean survival of 26.8 months. The overall survival at 2 and 5 years of nonmetastatic group was 81.1% and 47.5% respectively and in metastatic group was 35.1% and 0%, respectively. Poor performance status, distant metastasis, higher T stage, higher thrombus levels, and positive surgical margins were all predictors of decreased survival. Conclusions: Complete surgical resection in both nonmetastatic and metastatic RCC with IVC thrombus has long-term survival benefits. Neoadjuvant TKI therapy, with adequate preoperative planning, helps in decreasing the size of the thrombus and in safely avoiding bypass in level III and IV IVC thrombi.
Collapse
Affiliation(s)
- Shitangsu Kakoti
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rahul Jena
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anil Mandhani
- Department of Urology and Renal Transplant, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Uday Pratap Singh
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
6
|
Tiwari P, Kumar L, Singh G, Seth A, Thulkar S. Renal Cell Cancer: Clinicopathological Profile and Survival Outcomes. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_126_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: The incidence of renal cell cancer (RCC) is increasing worldwide. However, scant information is available from the Indian subcontinent regarding its clinicopathological characteristics and survival outcomes. We retrospectively analyzed data of patients suffering from RCC at our center over the last one decade (2004–2013) to generate information on these aspects. Materials and Methods: Case records of 423 patients treated between 2004 and 2013 were retrospectively analyzed. Baseline characteristics, histopathological information, and survival outcomes were assessed. Overall survival was calculated from the time of diagnosis to death due to any cause. Results: The median age was 52 years (range: 18–87 years). Male: female ratio was 3.5:1. The median duration of symptoms was 3 months (range: 0–24 months). Thirty-five patients (8.3%) were detected in asymptomatic state. The most common symptom was hematuria (53.2%) followed by flank pain (46.3%). The most common histology was clear cell subtype (71.4%). Two hundred and ninety-three (69.3%) patients presented with nonmetastatic disease whereas 130 (30.7%) had upfront metastatic disease. Five-year survival in Stages 1, 2, 3, and 4 was 92.7%, 72.9%, 54.6%, and 11.5%, respectively. Conclusion: Younger age, higher male–female ratio, lower proportion of asymptomatic patients, higher proportion of advanced stage at diagnosis, and lower stage-wise survival were some of the key findings.
Collapse
Affiliation(s)
- Priya Tiwari
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Geetika Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
7
|
Legris V, Sergerie M, Garceau P, Thibodeau-Jarry N. A Right Atrial Mass as Initial Presentation of a Hepatocellular Carcinoma. CJC Open 2021; 3:376-378. [PMID: 33778456 PMCID: PMC7985016 DOI: 10.1016/j.cjco.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is recognized to have a strong tendency for vascular invasion. However, right atrial (RA) involvement is uncommon. It has been principally described as a fortuitous discovery during oncology follow-up or as an autopsy finding of patients with known HCC. We present a case of a patient whose initial HCC presentation was an RA mass found during a dyspnea investigation. Thereby, on the basis of this new finding, clinicians should consider HCC in their differential diagnosis when discovering an RA mass.
Collapse
Affiliation(s)
- Valéry Legris
- Department of Medicine, Montreal Heart Institute, Montreal, Québec, Canada
| | - Mathieu Sergerie
- Department of Internal Medicine, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | - Patrick Garceau
- Department of Medicine, Montreal Heart Institute, Montreal, Québec, Canada
| | | |
Collapse
|
8
|
Abstract
In metastatic renal cell carcinoma (mRCC) patients, cardiac metastases are a rare and often a post-mortem finding. Clinical manifestations of cardiac metastases have a late onset and include pericardial effusions, heart failure and embolic phenomena. Treatment of cardiac metastasis is not yet standardized, and few data are available about the efficacy of TKI on treatment of cardiac metastases in mRCC patients. In this report, we describe the case of a 66-year-old male who presented with mRCC with lung and cardiac metastases treated with cabozantinib, a multikinase inhibitor that was administered in second line after disease progression with sunitinib. To date, there are no data about the safety and efficacy of cabozantinib in mRCC with cardiac metastasis. In a real word analysis, cabozantinib demonstrated to be associated to a modest risk of developing left ventricular heart failure. It is unknown if this risk is higher in mRCC population with cardiac metastases. We report the first evidence of efficacy and safety of cabozantinib in cardiac mRCC patients, probably due to its specific inhibition of several molecular intracellular pathways. Additional molecular and clinical studies are needed before well tolerated and efficacy of cabozantinib treatment for these patients can be fully understood.
Collapse
|
9
|
Kishore TA, Pathrose G, Raveendran V, Ganpule A, Gautam G, Laddha A, Pooleri GK, Desai M. Robot-assisted laparoscopic radical nephrectomy and inferior vena cava thrombectomy: A multicentre Indian experience. Arab J Urol 2020; 18:124-128. [PMID: 33029418 PMCID: PMC7473165 DOI: 10.1080/2090598x.2020.1738104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To assess feasibility of robot-assisted laparoscopic radical nephrectomy (RALRN) and inferior vena cava thrombectomy (IVCT) in treating renal tumours with level I–III IVC thrombi and to assess their outcomes. Patients and methods We conducted a retrospective analysis of RALRN-IVCTs, involving four centres across India, from September 2015 to June 2019. We analysed patients who underwent RALRN-IVCT for level I–III thrombi according to the Mayo classification. The total operative duration with console time, length of hospital stay, preoperative and postoperative creatinine, IVC clamp time and intraoperative blood loss were recorded. Results Of the 13 patients that underwent RALRN-IVCT, five had a level I thrombus, seven had level II, and one had a level III thrombus. In all, 11 of the patients had right-sided tumours and the remaining two had left-sided tumours. The mean (SD) age of the patients was 56.5 (12.3) years, the mean (SD) operative time was 329.5 (97.22) min, the mean (SD) console time was 222.5 (70) min, the mean (SD) blood loss was 395 (170) mL, and the mean (SD) IVC clamp time was 19.14 (9.5) min. The mean (SD) length of hospital stay was 7.8 (3.27) days. Of the 13 patients, 12 had clear cell renal cell carcinoma (RCC) and one had papillary RCC. The mean (range) follow-up was 19 (4–50) months. One patient had upfront metastasis and two patients developed metastasis, while 10 patients remained disease-free during the follow-up. Conclusion With appropriate patient selection, surgical planning and robotic experience, completely intracorporeal robotic level I–III IVCT is feasible and can be performed efficiently. Larger experiences, with longer follow-ups and comparisons with open surgery are needed to confirm these initial outcomes. Abbreviations ECOG: Eastern Cooperative Oncology Group; IVC: inferior vena cava; IVCT: inferior vena cava thrombectomy; (RAL)RN: (robot-assisted laparoscopic) radical nephrectomy
Collapse
Affiliation(s)
| | | | | | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urology Hospital, Nadiad, India
| | - Gagan Gautam
- Department of Urology, Max Hospital Saket, New Delhi, India
| | - Abhishek Laddha
- Department of Urology, Amrita Institute of Medical Sciences, Kochi, India
| | | | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urology Hospital, Nadiad, India
| |
Collapse
|
10
|
Jain D, Gandhi K, Reddy S, Gattupalli V, Mohan R. A stitch in time saves life: Massive tumor embolism. J Anaesthesiol Clin Pharmacol 2018; 34:411-413. [PMID: 30386034 PMCID: PMC6194845 DOI: 10.4103/joacp.joacp_377_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Divya Jain
- Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Komal Gandhi
- Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Seran Reddy
- Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vasavi Gattupalli
- Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Mohan
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
11
|
Crisan N, Andras I, Grad DL, Telecan T, Coman RT, de Cobelli O, Matei DV, Coman I. Dual Combined Laparoscopic Approach for Renal-Cell Carcinoma with Renal Vein and Level I-II Inferior Vena Cava Thrombus: Our Technique and Initial Results. J Endourol 2018; 32:837-842. [PMID: 29947249 DOI: 10.1089/end.2018.0228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To present our technique and initial results of dual combined retroperitoneal and transperitoneal laparoscopic approach for the treatment of renal-cell carcinoma (RCC) with level 0-II venous tumor thrombus. PATIENTS AND METHODS We included nine consecutive patients with RCC and level 0-II inferior vena cava (IVC) thrombus who underwent laparoscopic radical nephrectomy and IVC thrombectomy using dual combined laparoscopic approach in our department between January 2016 and June 2017. RESULTS The mean operative time was 150 minutes when cavotomy was not performed and 240 minutes when cavotomy with thrombectomy was required. The mean IVC clamping time was 24 minutes and the mean blood loss was 300 mL. We encountered no major intraoperative or postoperative complications (Clavien III-IV). The patients were discharged a mean of 7 days after the procedure. At the 6-month follow-up, all patients were alive. One patient presented a retroperitoneal enlarged lymph node and started systemic treatment. CONCLUSIONS The dual combined laparoscopic approach for kidney tumors with level 0-II IVC thrombus is feasible, reproducible, and especially useful in patients with complex renal pedicle. The technique provides early arterial control by retroperitoneal approach, which reduces the blood flow through the renal vein and has the advantage of minimal mobilization of the thrombus-bearing renal vein; it therefore lowers the risk of tumor embolism and intraoperative hemorrhage.
Collapse
Affiliation(s)
- Nicolae Crisan
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania .,2 Urology Department, Clinical Municipal Hospital , Cluj-Napoca, Romania
| | - Iulia Andras
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania .,2 Urology Department, Clinical Municipal Hospital , Cluj-Napoca, Romania
| | - Doru-Lucian Grad
- 2 Urology Department, Clinical Municipal Hospital , Cluj-Napoca, Romania
| | - Teodora Telecan
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Radu-Tudor Coman
- 3 Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | | | - Deliu Victor Matei
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania .,4 Urology Division, European Institute of Oncology , Milan, Italy
| | - Ioan Coman
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania .,2 Urology Department, Clinical Municipal Hospital , Cluj-Napoca, Romania
| |
Collapse
|
12
|
Bagheri MH, Ahlman MA, Lindenberg L, Turkbey B, Lin J, Cahid Civelek A, Malayeri AA, Agarwal PK, Choyke PL, Folio LR, Apolo AB. Advances in medical imaging for the diagnosis and management of common genitourinary cancers. Urol Oncol 2017; 35:473-491. [PMID: 28506596 PMCID: PMC5931389 DOI: 10.1016/j.urolonc.2017.04.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/05/2017] [Accepted: 04/15/2017] [Indexed: 01/01/2023]
Abstract
Medical imaging of the 3 most common genitourinary (GU) cancers-prostate adenocarcinoma, renal cell carcinoma, and urothelial carcinoma of the bladder-has evolved significantly during the last decades. The most commonly used imaging modalities for the diagnosis, staging, and follow-up of GU cancers are computed tomography, magnetic resonance imaging (MRI), and positron emission tomography (PET). Multiplanar multidetector computed tomography and multiparametric MRI with diffusion-weighted imaging are the main imaging modalities for renal cell carcinoma and urothelial carcinoma, and although multiparametric MRI is rapidly becoming the main imaging tool in the evaluation of prostate adenocarcinoma, biopsy is still required for diagnosis. Functional and molecular imaging using 18-fluorodeoxyglucose-PET and sodium fluoride-PET are essential for the diagnosis, and especially follow-up, of metastatic GU tumors. This review provides an overview of the latest advances in the imaging of these 3 major GU cancers.
Collapse
Affiliation(s)
- Mohammad H Bagheri
- Clinical Image Processing Service, Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Mark A Ahlman
- Nuclear Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD; Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Liza Lindenberg
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jeffrey Lin
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Ali Cahid Civelek
- Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Ashkan A Malayeri
- Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Piyush K Agarwal
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Les R Folio
- Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Andrea B Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| |
Collapse
|
13
|
Ghanney EC, Cavallo JA, Levin MA, Reddy R, Bander J, Mella M, Stone J, Schwartz M, Haines K, Gidwani U, Mehrazin R. Renal cell carcinoma with inferior vena cava thrombus extending to the right atrium diagnosed during pregnancy. Ther Adv Urol 2017; 9:155-159. [PMID: 28588653 DOI: 10.1177/1756287217701378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/04/2017] [Indexed: 11/15/2022] Open
Abstract
Only one case of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus diagnosed and treated during pregnancy has been reported in the literature. In that report, the tumor thrombus extended to the infrahepatic IVC (level II tumor thrombus). In the present case, a 37-year-old woman with lupus anticoagulant antibodies was diagnosed with RCC and IVC tumor thrombus extending to the right atrium (level IV tumor thrombus) at 24 weeks of pregnancy. The fetus was safely delivered by cesarean section at 30 weeks of gestation. At 4 days later, an open right radical nephrectomy and IVC and right atrial thrombectomy were performed on cardiopulmonary bypass (CPB) once the patient's hemodynamic status had been optimized. Fetal and maternal concerns included the risk of a thromboembolic event (due to increased hypercoagulability from pregnancy, active malignancy, and lupus anticoagulant), intraoperative hemorrhage risk (due to extensive venous collaterals and anticoagulation), and fetal morbidity and mortality (due to fetal lung immaturity). Standardized guidelines for treatment of RCC with or without IVC tumor thrombus during pregnancy are unavailable due to the infrequency of such cases. Treatment decisions are therefore individualized and this case report may inform the management of future patients diagnosed with RCC with level IV tumor thrombus during pregnancy.
Collapse
Affiliation(s)
- Efe C Ghanney
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaime A Cavallo
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew A Levin
- Departments of Anesthesiology and Genomics and Genetic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ramachandra Reddy
- Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey Bander
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Mella
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joanne Stone
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Myron Schwartz
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Umesh Gidwani
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reza Mehrazin
- Assistant Professor, Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1272, New York, NY 10029, USA
| |
Collapse
|
14
|
Overholser S, Raheem O, Zapata D, Kaushik D, Rodriguez R, Derweesh IH, Liss MA. Radiologic indicators prior to renal cell cancer thrombectomy: Implications for vascular reconstruction and mortality. Urol Ann 2016; 8:312-6. [PMID: 27453653 PMCID: PMC4944624 DOI: 10.4103/0974-7796.184888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Renal cancer may invade the inferior vena cava (IVC) creating more complex surgical intervention. We investigate radiologic findings that may predict vascular reconstruction prior to surgery and future renal cancer-specific mortality. Materials and Methods: Radiologic findings included Mayo Clinic risk factors for vascular reconstruction: Right-sided tumor, anteroposterior diameter of the IVC at the ostium of the renal vein ≥24.0 mm, and radiologic identification of complete occlusion of the IVC. Additional factors included thrombus in the lumen of the hepatic veins and metastasis. Along with other demographic factors, analysis included Chi-squared analysis for vascular reconstruction and logistic regression for mortality. A Kaplan–Meier curve was created for the most significant radiologic factor. Results: Thirty-seven patients underwent IVC tumor thrombectomy at two institutions from April 2007 to February 2015. We found that Mayo risk factors of 0, 1, 2, and 3 and the proportions of vascular reconstruction of 0%, 0%, 12.5%, and 13.6%, respectively (P = 0.788). Hepatic vein involvement was the most significant determinate of renal cell carcinoma-specific mortality in multivariable analysis, controlling for the size of IVC at the hepatic veins, pulmonary metastasis, and Fuhrman grade (P = 0.02, Log-rank P = 0.002). Conclusion: Mayo risk factors did not predict vascular reconstruction in our small cohort of Level II–Level IV IVC thrombus undergoing IVC thrombectomy. Tumor thrombus traveling into the lumen of the hepatic veins was a significant risk factor for accelerated mortality.
Collapse
Affiliation(s)
- Stephen Overholser
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Omer Raheem
- Department of Urology, University of California San Diego Health System, San Diego, CA, USA
| | - David Zapata
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ronald Rodriguez
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ithaar H Derweesh
- Department of Urology, University of California San Diego Health System, San Diego, CA, USA
| | - Michael A Liss
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| |
Collapse
|
15
|
Mastoraki A, Mastoraki S, Tsikala-Vafea M, Papanikolaou IS, Lazaris A, Smyrniotis V, Arkadopoulos N. Prognostic Benefit of Surgical Management of Renal Cell Carcinoma Invading the Inferior Vena Cava. Indian J Surg Oncol 2016; 8:14-18. [PMID: 28127177 DOI: 10.1007/s13193-016-0528-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 04/29/2016] [Indexed: 01/01/2023] Open
Abstract
Renal cell carcinoma (RCC) accounts for approximately 3 % of adult malignancies and 90-95 % of neoplasms arising from the kidney. One of the unique features of RCC is the tumor thrombus formation that migrates into the venous system including renal vein (RV) and inferior vena cava (IVC). Only 10 % of patients with RCC present with the classic triad of flank pain, hematuria and defined mass, while 25-30 % of affected patients are asymptomatic. Signs of para-neoplastic syndrome such as hypercalcemia, hypertension, anemia, cachexia and increased erythrocyte sedimentation rate (ESR) are often apparent. Extension of tumor thrombus into the venous system is depicted by radiological examinations, such as contrast enhanced Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and vena cavography. The level of the thrombus is mostly determined according to the Mayo classification. Despite recent research on the therapeutic strategies against advanced RCC, surgical resection appears the only potentially curative approach. Aggressive surgical management including nephrectomy with thrombectomy is currently the standard therapeutic approach for RCC patients with tumor thrombus extending to the RV or the IVC. Pre-surgical down-staging with the use of molecular targeted therapy has also been proposed. Alternative therapies, such as radio- and chemotherapy proved insufficient. The aim of this review is to evaluate the results of surgical treatment for RCC invading IVC with special reference to the extent of its histological spread. Review of recent world literature was accomplished to provide an update on the current concepts of surgical management of the disease.
Collapse
Affiliation(s)
- Aikaterini Mastoraki
- Athens University Medical School, Attikon University Hospital, Chaidari, Athens Greece
| | - Sotiria Mastoraki
- Athens University Medical School, Attikon University Hospital, Chaidari, Athens Greece
| | - Maria Tsikala-Vafea
- Athens University Medical School, Attikon University Hospital, Chaidari, Athens Greece
| | | | - Andreas Lazaris
- Athens University Medical School, Attikon University Hospital, Chaidari, Athens Greece
| | - Vassilios Smyrniotis
- Athens University Medical School, Attikon University Hospital, Chaidari, Athens Greece
| | - Nikolaos Arkadopoulos
- Athens University Medical School, Attikon University Hospital, Chaidari, Athens Greece
| |
Collapse
|
16
|
Robotic Level III IVC Tumor Thrombectomy: Duplicating the Open Approach. Urology 2016; 90:204-7. [PMID: 26802799 DOI: 10.1016/j.urology.2016.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 12/07/2015] [Accepted: 01/14/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe our surgical technique for robotic radical nephrectomy and thrombectomy for renal cell carcinoma and associated level III inferior vena cava (IVC) thrombus with retroperitoneal lymph node dissection. METHODS The patient is a 75-year-old Caucasian man with a 10-cm right renal neoplasm and associated level III tumor thrombus. After preoperative imaging was reviewed, a robotic approach was planned. Real-time intraoperative transesophageal ultrasonography was performed to assess the cranial extent of tumor thrombus. The major steps of our technique include early inter-aortocaval control of the right renal artery, circumferential mobilization of the IVC, contralateral renal vein control, cavotomy, thrombectomy, and reconstruction of the IVC. RESULTS Operative time was 5 hours and 53 minutes (353 minutes) with 150 mL estimated blood loss. The patient was allowed to have a clear liquid diet immediately after surgery and was discharged home on postoperative day 3. Final pathology demonstrated a 9.8-cm clear cell renal cell carcinoma, nuclear grade 3 with a pT3bN1 stage. CONCLUSIONS With adequate team experience and preparation, robotic radical nephrectomy and IVC tumor thrombectomy for level III tumor thrombus is challenging but feasible in select patients. Herein we describe our robotic technique which duplicates the open approach. This minimally invasive approach may offer lower estimated blood loss, improved pain control, and expedited recovery.
Collapse
|
17
|
Polańska-Płachta M, Proczka R, Dudek M, Ostrowska M, Polański JA. Surgery for retrohepatic caval thrombus in patients with advanced renal cell carcinoma: a case series. World J Surg Oncol 2016; 14:11. [PMID: 26769197 PMCID: PMC4714474 DOI: 10.1186/s12957-015-0765-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 12/30/2015] [Indexed: 11/16/2022] Open
Abstract
Background Thrombotic involvement of the inferior vena cava (IVC) occurs in about 10 % of all patients with renal cell carcinoma (RCC). It is treated with radical resection of tumor and thrombus. We present the results of a recent case series of 20 patients with retrohepatic IVC thrombus. Methods Our cohort of 20 patients included 16 primary resections (radical nephrectomy and thrombectomy with and without vascular graft), three recurrences primarily operated on elsewhere (thrombectomy and vascular graft), and one recurrence due to a new liver metastasis. Results All surviving patients were discharged with a patent IVC. The overall mortality rate was 10 %, and the overall complication rate was 35 %. Both are in keeping with results presented worldwide. Conclusions Our series provides a corroborating extension to the existing dataset on RCC-related IVC thrombus removal. It confirms that the radical surgical approach can be performed safely and successfully with respect to venous patency.
Collapse
Affiliation(s)
- Małgorzata Polańska-Płachta
- 2nd Department of General, Vascular and Oncologic Surgery, 2nd Faculty of Medicine with English Division and Physiotherapy Division, Czerniakowski Hospital, Medical University of Warsaw, Stepinska Str. 19/25, 00-739, Warsaw, Poland.
| | - Robert Proczka
- 2nd Department of General, Vascular and Oncologic Surgery, 2nd Faculty of Medicine with English Division and Physiotherapy Division, Czerniakowski Hospital, Medical University of Warsaw, Stepinska Str. 19/25, 00-739, Warsaw, Poland.
| | - Magdalena Dudek
- Department of Urology, 1st Faculty of Medicine, Medical University of Warsaw, Lindleya Str. 4, 02-005, Warsaw, Poland.
| | - Małgorzata Ostrowska
- 2nd Department of General, Vascular and Oncologic Surgery, 2nd Faculty of Medicine with English Division and Physiotherapy Division, Czerniakowski Hospital, Medical University of Warsaw, Stepinska Str. 19/25, 00-739, Warsaw, Poland.
| | - Jerzy A Polański
- 2nd Department of General, Vascular and Oncologic Surgery, 2nd Faculty of Medicine with English Division and Physiotherapy Division, Czerniakowski Hospital, Medical University of Warsaw, Stepinska Str. 19/25, 00-739, Warsaw, Poland.
| |
Collapse
|
18
|
Sood A, Jeong W, Barod R, Bahnson E, Kirura P, Abdollah F, Bhandari M, Bahnson R, Menon M. Robot-assisted hepatic mobilization and control of suprahepatic infradiaphragmatic inferior vena cava for level 3 vena caval thrombectomy: An IDEAL stage 0 study. J Surg Oncol 2015; 112:741-5. [DOI: 10.1002/jso.23980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/04/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Akshay Sood
- Vattikuti Urology Institute; Henry Ford Health System; Detroit Michigan
| | - Wooju Jeong
- Vattikuti Urology Institute; Henry Ford Health System; Detroit Michigan
| | - Ravi Barod
- Vattikuti Urology Institute; Henry Ford Health System; Detroit Michigan
| | - Eamonn Bahnson
- Department of Urology; University of Cincinnati; Cincinnati Ohio
| | - Parfait Kirura
- Department of Urology; Ohio State University; Columbus Ohio
| | - Firas Abdollah
- Vattikuti Urology Institute; Henry Ford Health System; Detroit Michigan
| | - Mahendra Bhandari
- Vattikuti Urology Institute; Henry Ford Health System; Detroit Michigan
| | - Robert Bahnson
- Department of Urology; Ohio State University; Columbus Ohio
| | - Mani Menon
- Vattikuti Urology Institute; Henry Ford Health System; Detroit Michigan
| |
Collapse
|
19
|
Shao P, Li J, Qin C, Lv Q, Ju X, Li P, Shao Y, Ni B, Yin C. Laparoscopic Radical Nephrectomy and Inferior Vena Cava Thrombectomy in the Treatment of Renal Cell Carcinoma. Eur Urol 2014; 68:115-22. [PMID: 25534934 DOI: 10.1016/j.eururo.2014.12.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/03/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Radical nephrectomy with inferior vena cava (IVC) thrombectomy is the preferred treatment for renal cell carcinoma (RCC) with IVC thrombus. However, IVC thrombectomy using a laparoscopic approach has not been reported for high-level thrombi. OBJECTIVE To describe the surgical technique for laparoscopic IVC thrombectomy in patients with different thrombus levels and to assess its safety and feasibility. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of medical records for 11 patients with right-side RCC, including six patients with level II IVC thrombus and five patients with level IV thrombus. SURGICAL PROCEDURE Laparoscopic thrombectomy for level II thrombus was performed after clamping the infrarenal IVC, left renal vein, and infrahepatic IVC. Laparoscopic thrombectomy and thoracoscope-assisted open atriotomy for level IV thrombus were performed after establishing cardiopulmonary bypass and clamping the infrarenal IVC, left renal vein, and hepatoduodenal ligament. MEASUREMENTS The intraoperative variables, postoperative complications, and surgical outcomes were assessed. RESULTS AND LIMITATIONS The median operative time was 210min. The median IVC clamping time for patients with level II and level IV thrombus was 16.5 and 31min, respectively. The median estimated blood loss was 510ml, and no major intraoperative or postoperative complications occurred. One patient with level IV thrombus died of brain metastasis 6 mo after the operation, and the remaining ten patients had no local recurrence or distant metastasis during a median follow-up period of 31 mo. CONCLUSIONS Laparoscopic IVC thrombectomy for level II thrombus and well-selected level IV thrombus may be a safe and technically feasible alternative to open surgery. PATIENT SUMMARY We studied the treatment of patients with an inferior vena cava thrombus at different levels using a laparoscopic approach. This technique was safe and feasible in well-selected patients.
Collapse
Affiliation(s)
- Pengfei Shao
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Li
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Qin
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Lv
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaobing Ju
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pu Li
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yongfeng Shao
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Buqing Ni
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Changjun Yin
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| |
Collapse
|
20
|
|
21
|
Kulkarni J, Jadhav Y, Valsangkar RS. IVC Thrombectomy in Renal Cell Carcinoma-Analysis of Out Come Data of 100 Patients and Review of Literature. Indian J Surg Oncol 2012; 3:107-13. [PMID: 23730099 PMCID: PMC3392477 DOI: 10.1007/s13193-011-0114-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 12/06/2011] [Indexed: 12/27/2022] Open
Abstract
To review our experience of RCC with IVC thrombus in terms of clinical presentation, principles of surgical management in contemporary era, also an impact of clinico-pathological factors on prognosis. Total 100 patients who underwent radical nephrectomy and IVC thrombectomy between 1991-2008 were included in this retrospective analysis. Data was analysed in terms of clinical pathological factors, survivals and compared with contemporary literature. The extent tumour thrombus was infrahepatic in 58 retro hepatic in 28 and suprahepatic in 14 patients including 6 with right atrial thrombus. The immediate postoperative mortality was 2% and incidence of major postoperative non fatal complications was 38%, which were managed conservatively. The overall and disease free 5 year survival was 63% and 55%. Further amongst the histological types, patients with clear cell tumours had the best (DFS- 71.42%), and those with papillary had the poor (DFS- 30.76%) outcome. Grade II tumors had better survivals as compared to grade IV (DFS 75.39% vs 23.52%, p < 0.05). Loco- regional extent wise 74% patients without perinephric fat invasion were free from disease at 5 years as compared to 30% of those who had perinephric fat invasion (p < 0.01). Similarly 5 year DFS was 76.11% in patients with negative nodes as compared to 12% in positive nodes (p < 0.01). In conclusion radical nephrectomy with IVC thrombectomy still remains the most effective therapeutic option in management in this clinical setting. Although this is complicated surgery success with multi disciplinary approach excellent survival outcome can be obtained. Further pathological factors, such as loco-regional spread and grade of tumor, rather than clinical factors influence long term survival.
Collapse
Affiliation(s)
- Jagdeesh Kulkarni
- Department of Urology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra India
| | - Yogesh Jadhav
- Department of Urology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra India
| | - Rohan S. Valsangkar
- Department of Urology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra India
| |
Collapse
|
22
|
Helfand BT, Smith ND, Kozlowski JM, Eskandari MK. Vena Cava Thrombectomy and Primary Repair After Radical Nephrectomy for Renal Cell Carcinoma: Single-Center Experience. Ann Vasc Surg 2011; 25:39-43. [DOI: 10.1016/j.avsg.2010.05.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 04/27/2010] [Accepted: 05/21/2010] [Indexed: 11/30/2022]
|
23
|
Qi J, Gu Z, Chen F, Shen H, Chen J, Zhang L, Wang W. Management of renal cell carcinoma with tumor thrombus in renal vein and the inferior vena cava. Ann Vasc Surg 2010; 24:1089-93. [PMID: 20471214 DOI: 10.1016/j.avsg.2010.02.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 09/22/2009] [Accepted: 02/11/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND The article aims to sum up experience in the treatment of renal cell carcinoma complicated with tumor thrombus in renal vein and inferior vena cava. METHODS A retrospective review was made on the diagnosis, treatment, and prognosis of 15 cases of renal carcinoma complicated with venous tumor thrombus from July 1994 to July 2006. RESULTS The diagnosis of 93% (14/15) cases was confirmed by preoperative computed tomography or magnetic resonance imaging. Of the 15 cases, two had simple renal vein tumor thrombus of left kidney and 13 had inferior vena cava tumor thrombus; of the latter, nine were type I (pararenal type), three type II (subhepatic type), and one type III (intrahepatic type). Of the 12 patients who received surgical treatment, 11 had the renal tumors completely resected, the venous tumor thrombus removed, and lymph nodes cleared. Palliative excision was performed in one patient with a left kidney tumor because of adjacent adhesion. All the three patients who did not receive surgical treatment died, with a mean survival period of 7 months. Of the 12 surgical patients who received surgical treatment, three were lost during follow-up, and the other nine were followed up for 4-72 months; of these 9 patients, three (25%) survived tumor-free for more than 5 years, three for 1-3 years, and the other three died of metastasis within 1 year. CONCLUSION Computerized tomography and magnetic resonance imaging are the best choice for noninvasive diagnosis of renal cell carcinoma complicated with inferior vena cava tumor thrombus. For patients without metastasis, radical resection of both the tumor and the thrombus often offers a relatively satisfactory outcome.
Collapse
Affiliation(s)
- Jun Qi
- Department of Urology, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, P.R. China
| | | | | | | | | | | | | |
Collapse
|
24
|
Yang Y, Sun S, Xiao X, Song Y, Cai W, Wang M, Zhang X. Temporary balloon occlusion of inferior vena cava in resection of renal tumor with vena cava thrombus extension. Urology 2009; 73:645-8. [PMID: 19167042 DOI: 10.1016/j.urology.2008.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 09/22/2008] [Accepted: 11/04/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate a novel and effective method to occlude the inferior vena cava (IVC) during surgical management of a renal tumor with a tumor thrombus extension into the IVC. METHODS We retrospectively reviewed the records of 10 patients with renal cell carcinoma or renal angiomyolipoma with tumor thrombus extending into the IVC who had undergone surgical intervention at our institute from May 2005 to May 2006. The balloon occlusion of the IVC was performed during surgery to decrease the risk of pulmonary embolism. RESULTS One patient could not tolerate the test occlusion of the IVC and the procedure was converted to IVC-right atrium bypass. The remaining 9 patients successfully underwent nephrectomy and thrombectomy with the help of temporary balloon obstruction of the IVC without perioperative mortality or morbidity. The blood pressure and circulatory status were stably maintained during occlusion of the IVC. CONCLUSIONS Temporary balloon occlusion of the IVC is a simple and reliable technique that decreases the risk of pulmonary embolism and facilitates the resection of renal tumor with levels II and III IVC thrombus.
Collapse
Affiliation(s)
- Yong Yang
- Department of Urology, PLA General Hospital, Beijing, China.
| | | | | | | | | | | | | |
Collapse
|
25
|
Nouh MAAM, Inui M, Kakehi Y. Renal Cell Carcinoma with IVC Thrombi; Current Concepts and Future Perspectives. Clin Med Oncol 2008; 2:247-56. [PMID: 21892286 PMCID: PMC3161638 DOI: 10.4137/cmo.s464] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The incidence of venous extension to the inferior vena cava (IVC) in renal cell carcinoma (RCC) is markedly increased recently mostly due to the advances in diagnostic modalities. Such vascular invasion implies a heightened biologic behavior and a surgical challenge during the course of treatment. In this study, we reviewed the classification guidelines, recent diagnostic tools and up-to-date therapeutic modalities for RCC with IVC tumor thrombi added to the prognostic significance regarding the pathologic nature of vascular invasion; cephalad extent of thrombi and any associated distant metastasis. Also, we are providing our suggestion regarding the use of angioscopy for removal of IVC thrombi in a relatively bloodless field without aggressive surgical manipulations or shunt techniques for maintenance of hemodynamic stability.
Collapse
|
26
|
Mangiavillano B, Arcidiacono PG, Pasta A, Bertini R, Boemo C, Testoni PA. Could EUS be useful for evaluating right renal vein and inferior vena cava thrombosis due to renal cell carcinoma? Report of 3 cases. Gastrointest Endosc 2007; 66:154-6. [PMID: 17591490 DOI: 10.1016/j.gie.2006.12.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Accepted: 12/18/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND More than 200,000 new cases of kidney cancer are diagnosed annually. The reported incidence of inferior vena cava (IVC) involvement in patients with renal-cell carcinoma (RCC) ranges from 4% to 10%. Standard imaging modalities are unable to distinguish the inner structure of a thrombus and whether the vessel wall is invaded. OBJECTIVE To assess the utility of EUS for investigating IVC thrombosis because of RCC, particularly the thrombus characteristics and the involvement of the IVC, and the right and left renal veins. DESIGN, SETTING, AND PATIENTS EUS was used to investigate 3 patients with RCC and IVC involvement. The endosonographer was blinded to the results of other imaging techniques. INTERVENTIONS A diagnostic EUS was performed with the patient under deep sedation (propofol) in 2 patients, and the third patient was given midazolam and fentanyl intravenously. MAIN OUTCOME MEASUREMENT EUS identified a possible neoplastic invasion of the renal veins and/or IVC, distinguishing between the neoplastic hypoechoic and non-neoplastic hyperechoic thrombus in the IVC lumen and indicated the solidity of the inner structure of the clot. RESULTS EUS is useful in the vascular staging of RCC with suspected neoplastic involvement and thrombosis of either the renal veins, the IVC, hepatic veins, or the right atrium. EUS helped establish the consistency of the IVC thrombus and provided useful information to the surgeon for planning the use of a temporary, intraoperative caval filter. LIMITATIONS The limitation of this study was the small number of patients. More cases are needed before stating that EUS could be useful in the staging of the neoplastic thrombi because of RCC. CONCLUSIONS Diagnostic EUS can help in the detection and the staging of IVC thrombosis because of RCC. Further data are needed to evaluate its real impact on surgical management.
Collapse
Affiliation(s)
- Benedetto Mangiavillano
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS Vita-Salute San Raffaele University, San Raffaele Hospital Scientific Institute, Milan, Italy
| | | | | | | | | | | |
Collapse
|
27
|
Renal cell carcinoma extending from superior vena cava into right atrium. J Am Soc Echocardiogr 2007; 20:538.e7-8. [PMID: 17485000 DOI: 10.1016/j.echo.2006.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Indexed: 11/26/2022]
Abstract
Tumoral invasion of inferior vena cava by renal cell carcinoma is reported to be relatively frequent. Usually the tumor grows intraluminally into the renal vein and inferior vena cava as an extension of primary tumor. In this report, we present an unusual case of venous system involvement, invasion of renal cell carcinoma into superior vena cava.
Collapse
|
28
|
Nogales Asensio JM, Reyes González Fernández M, Alonso Bravo M, Merchán Herrera A. Kidney tumour mimicking cardiac mass. Int J Cardiol 2006; 106:401-3. [PMID: 16337053 DOI: 10.1016/j.ijcard.2004.12.086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Accepted: 12/31/2004] [Indexed: 10/25/2022]
Abstract
The discovery of a mass in the right atrium obliges the clinician to perform a broad differential diagnosis between a primary cardiac tumour (with myxoma being the most frequent), invasion of an extracardiac tumour, vegetations on the tricuspid valve, and an atrial thrombus. We describe the case of a patient who was admitted to our service with a diagnosis of suspected myxoma based on the chance transthoracic echocardiographic discovery of a right atrial mass. A transesophageal echocardiogram showed the process to be extracardiac, and magnetic resonance imaging showed it to originate at the renal level extending via the inferior vena cava to the right atrium. Tumour extension with thrombosis of the vena cava is a relatively frequent complication of renal carcinoma, but only exceptionally does it reach the right atrium. It is also exceptional that this was a chance finding in an asymptomatic patient.
Collapse
|
29
|
Louvet A, Lazard P, Denis B. Phaeochromocytoma treated by en bloc resection including the suprarenal caudal vena cava in a dog. J Small Anim Pract 2005; 46:591-6. [PMID: 16355735 DOI: 10.1111/j.1748-5827.2005.tb00292.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 10-year-old, neutered male Cairn terrier was examined after experiencing intermittent vomiting of several months' duration and sudden onset of acute depression. Abdominal ultrasound examination revealed an adrenal mass invading the suprarenal part of the caudal vena cava. The vascular invasion could not be corrected so en bloc ligation/excision of the adrenal neoplasm and the suprarenal part of the vena cava was performed. Microscopic examination identified an adrenal phaeochromocytoma. The dog recovered well and had no significant vascular or renal dysfunction at follow-up 20 months after surgery. To the authors' knowledge, this is the first report of a dog surviving long term after resection of the suprarenal caudal vena cava.
Collapse
Affiliation(s)
- A Louvet
- Small Animal Veterinary Clinic, Saint Germain en Laye, France
| | | | | |
Collapse
|
30
|
Bissada NK, Yakout HH, Babanouri A, Elsalamony T, Fahmy W, Gunham M, Hull GW, Chaudhary UB. Long-term experience with management of renal cell carcinoma involving the inferior vena cava. Urology 2003; 61:89-92. [PMID: 12559273 DOI: 10.1016/s0090-4295(02)02119-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To evaluate the long-term outcome and prognosis and influence of patient and tumor characteristics and therapeutic interventions on patients with renal cell carcinoma (RCC) extending to the inferior vena cava (IVC). METHODS The data of 75 patients (51 men and 24 women; age range 27 to 92 years) with RCC and involvement of the IVC, including 49 without and 26 with metastatic disease, treated between July 1973 and December 1998 were reviewed. The clinical presentation, laboratory and imaging investigations, extent and level of caval involvement, operative details, and estimated blood loss, as well as the postoperative course, morbidity, and actuarial and disease-free survival were analyzed. RESULTS Seventy-five patients between 27 and 92 years old with RCC involving the IVC were studied. Of the 54 operative patients, 48 had no metastasis and 6 had metastatic disease; 32 had IVC tumor extension to the infrahepatic or low retrohepatic IVC, 7 had high intrahepatic IVC extension, and 15 had right atrial extension. In 7 patients, tumor had invaded the IVC wall. Partial IVC wall excision was done in 4 patients and resection of a complete segment of the IVC in 3 patients. Tube graft to replace a segment of the IVC was used in 2 patients. Patients with intracardiac extension were initially treated with cardiopulmonary bypass. Subsequently, profound hypothermia and circulatory arrest were also used. Three patients died in the postoperative period: two with and one without metastatic disease. The follow-up period ranged between 25 and 144 months. Of the 48 patients without evidence of metastasis at surgery, the perioperative mortality rate was 2%. Twenty-two patients (47%) were alive without evidence of metastases, 4% developed solitary metastasis, and 36% eventually developed multiple metastases. CONCLUSIONS Our long-term experience confirms that of other investigators that nonmetastatic RCC with extension into the IVC is a potentially curable condition provided complete removal can be achieved. The level of extension of the tumor thrombus dictates the surgical techniques used for successful removal of the tumor thrombus. The treatment of patients with caval involvement and metastatic disease at presentation needs to be carefully individualized. Those with extensive multiorgan metastases continued to do poorly irrespective of the therapeutic approach chosen.
Collapse
Affiliation(s)
- Nabil K Bissada
- Medical University of South Carolina, Charleston, South Carolina 29425, USA
| | | | | | | | | | | | | | | |
Collapse
|