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Nini A, Muttin F, Cianflone F, Carenzi C, Luciano R, Catena M, Larcher A, Salvioni M, Cazzaniga W, Pederzoli F, Matloob R, Colombo R, Paganelli M, Salonia A, Briganti A, Doglioni C, Zangrillo A, DE Cobelli F, Rigatti P, Freschi M, Cornero G, Nicoletti R, Aldrighetti L, Montorsi F, Capitanio U, Bertini R. Perioperative and oncologic outcomes of open radical nephrectomy and inferior vena cava thrombectomy with liver mobilization and Pringle maneuver for Mayo III level tumor thrombus: single institution experience. Minerva Urol Nephrol 2020; 73:746-753. [PMID: 33242949 DOI: 10.23736/s2724-6051.20.03844-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Scarce data are available regarding the technique and outcomes for patients with RCC and Mayo III caval thrombi. The aim of this study was to report surgical and oncological outcomes of RCC patients with Mayo III thrombi treated with radical nephrectomy and thrombectomy after liver mobilization (LM) and Pringle maneuver (PM). METHODS Retrospective analysis of surgical technique, outcomes and cancer control in 19 patients undergoing LM and PM in a single tertiary care institution were analyzed. RESULTS Overall, 78% of the patients had performance status ECOG 1 and 58% had a Comorbidity Index >2. Median surgical time was 305 minutes (IQR 264-440). Intraoperative complications were reported for 39% of patients and postoperative complications for 58% (only grade 1 and 2). Intensive Care Unit support was necessary in 16% of the cases. Median length of hospital stay was 9 days (IQR: 7-11). Thirty- and 90-day mortality were 5% and 15%. Two-year overall survival and cancer-specific survival were 60% and 62%, respectively. CONCLUSIONS We reported surgical techniques, intra- and perioperative complications and follow-up in the largest cohort of RCC patients requiring LM and PM.
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Affiliation(s)
- Alessandro Nini
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy.,Department of Urology and Pediatric Urology, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Fabio Muttin
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Cianflone
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Cristina Carenzi
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Roberta Luciano
- Unit of Pathology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Catena
- Unit of Hepatobiliary Surgery, Department of General Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Larcher
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Salvioni
- Unit of Radiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Walter Cazzaniga
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Filippo Pederzoli
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rayan Matloob
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Renzo Colombo
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michele Paganelli
- Unit of Hepatobiliary Surgery, Department of General Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alberto Briganti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Claudio Doglioni
- Unit of Pathology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- Unit of Anesthesiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco DE Cobelli
- Unit of Radiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizio Rigatti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Freschi
- Unit of Pathology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Guglielmo Cornero
- Unit of Anesthesiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Nicoletti
- Unit of Radiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Aldrighetti
- Unit of Hepatobiliary Surgery, Department of General Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Umberto Capitanio
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Roberto Bertini
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy - .,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
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Spelde A, Steinberg T, Patel PA, Garcia H, Kukafka JD, MacKay E, Gutsche JT, Raiten JM, Augoustides JGT. Role of the Pulmonary Artery Catheter in Integrated Management of Renal Cell Carcinoma With Significant Caval Extension of Tumor Thrombus. J Cardiothorac Vasc Anesth 2017; 32:e63-e64. [PMID: 29229255 DOI: 10.1053/j.jvca.2017.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Audrey Spelde
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Toby Steinberg
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Harry Garcia
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jeremy D Kukafka
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessie M Raiten
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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