Introduction: The authors of this paper assessed the surgical management and outcome of renal cancers when tumor thrombus extended into the inferior vena cava (IVC). Methods: From 2000 to 2015, 46 radical nephrectomies were performed on patients with tumor thrombus in the IVC. The mean age of the patients was 60 ± 11 years. Radical nephrectomy and thrombectomies were performed in a single session. There were 18 level-IV, 23 level-III, and 5 level-II tumor thrombi. The operations were performed using cardiopulmonary bypass in 14 patients, while deep hypothermic cardiac arrest was carried out in 4 cases. Results: The mean size of the tumors was 9.4 ± 3.5 cm. Histology showed the tumor stages to be pT3b in 21cases, pT3c in 22, and pT4 in 3 patients. The mean follow-up period of the patients was 3.6 ± 3.0 years. During the follow-up period, local recurrence was observed in 7 patients, while distant metastases occurred in 8 cases. The median time to progression was 37 ± 27 months. The 5-year overall survival was 43.7%. Conclusions: Radical nephrectomy and thrombectomy provided reasonable long-term survival for patients with renal cancer and IVC thrombus. However, tumor progression was detected in 41.6%. The presence of tumor thrombus had a negative effect on tumor progression and survival.

Keywords:
Renal cancer, Tumor thrombus, Inferior vena cava, Thrombus level
1.
Nwadei IU, Lorentz A, Patil D, Dimarco MA, Master VA, Osunkoya AO: Renal cell carcinoma with vena caval involvement: a contemporary clinicopathologic analysis of 53 cases. Hum Pathol 2016;49:83-89.
2.
Kaplan S, Ekici S, Dogan R, Demircin M, Ozen H, Pasaoglu I: Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. Am J Surg 2002;183:292-299.
3.
Zisman A, Wieder JA, Pantuck AJ, Chao DH, Dorey F, Said JW, Gitlitz BJ, deKernion JB, Figlin RA, Belldegrun AS: Renal cell carcinoma with tumor thrombus extension: biology, role of nephrectomy and response to immunotherapy. J Urol 2003;169:909-916.
4.
Marshall FF, Reitz BA: Supradiaphragmatic renal cell carcinoma tumor thrombus: indications for vena caval reconstruction with pericardium. J Urol 1985;133:266-268.
5.
Skinner DG, Pritchett TR, Lieskovsky G, Boyd SD, Stiles QR: Vena caval involvement by renal cell carcinoma. Surgical resection provides meaningful long-term survival. Ann Surg 1989;210:387-392; discussion 392-394.
6.
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.
7.
Martinez-Salamanca JI, Herranz F, Verdu F, Pedemonte G, Moralejo M, Cabello R, Monzo JI, Lledo E, Escribano G, Moncada I, Hernandez C: [Surgical treatment of renal adenocarcinoma with venous thrombus]. Arch Esp Urol 2005;58:295-304.
8.
Rigaud J, Hetet JF, Braud G, Battisti S, Le Normand L, Glemain P, Karam G, Bouchot O: [Oncological results of renal cancer with inferior vena cava thrombosis after nephrectomy]. Prog Urol 2006;16:297-302.
9.
Rigaud J, Hetet JF, Braud G, Battisti S, Le Normand L, Glemain P, Karam G, Bouchot O: Surgical care, morbidity, mortality and follow-up after nephrectomy for renal cancer with extension of tumor thrombus into the inferior vena cava: retrospective study since 1990s. Eur Urol 2006;50:302-310.
10.
Toren P, Abouassaly R, Timilshina N, Kulkarni G, Alibhai S, Finelli A: Results of a national population-based study of outcomes of surgery for renal tumors associated with inferior vena cava thrombus. Urology 2013;82:572-577.
11.
Yap SA, Horovitz D, Alibhai SM, Abouassaly R, Timilshina N, Finelli A: Predictors of early mortality after radical nephrectomy with renal vein or inferior vena cava thrombectomy - a population-based study. BJU Int 2012;110:1283-1288.
12.
Katayama H, Ito A, Kakoi N, Shimada S, Saito H, Arai Y: A case of renal cell carcinoma with inferior vena cava tumor thrombus diagnosed during pregnancy. Urol Int 2014;92:122-124.
13.
Tsuji Y, Goto A, Hara I, Ataka K, Yamashita C, Okita Y, Kamidono S: Renal cell carcinoma with extension of tumor thrombus into the vena cava: surgical strategy and prognosis. J Vasc Surg 2001;33:789-796.
14.
Vaidya A, Ciancio G, Soloway M: Surgical techniques for treating a renal neoplasm invading the inferior vena cava. J Urol 2003;169:435-444.
15.
Wotkowicz C, Libertino JA, Sorcini A, Mourtzinos A: Management of renal cell carcinoma with vena cava and atrial thrombus: minimal access vs median sternotomy with circulatory arrest. BJU Int 2006;98:289-297.
16.
Zini L, Haulon S, Decoene C, Amara N, Villers A, Biserte J, Leroy X, Koussa M: Renal cell carcinoma associated with tumor thrombus in the inferior vena cava: surgical strategies. Ann Vasc Surg 2005;19:522-528.
17.
Lambert EH, Pierorazio PM, Shabsigh A, Olsson CA, Benson MC, McKiernan JM: Prognostic risk stratification and clinical outcomes in patients undergoing surgical treatment for renal cell carcinoma with vascular tumor thrombus. Urology 2007;69:1054-1058.
18.
Haferkamp A, Bastian PJ, Jakobi H, Pritsch M, Pfitzenmaier J, Albers P, Hallscheidt P, Müller SC, Hohenfellner M: Renal cell carcinoma with tumor thrombus extension into the vena cava: prospective long-term followup. J Urol 2007;177:1703-1708.
19.
Ciancio G, Manoharan M, Katkoori D, De Los Santos R, Soloway MS: Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: single-center experience. Eur Urol 2010;57:667-672.
20.
Wagner B, Patard JJ, Méjean A, Bensalah K, Verhoest G, Zigeuner R, Ficarra V, Tostain J, Mulders P, Chautard D, Descotes JL, de la Taille A, Salomon L, Prayer-Galetti T, Cindolo L, Valéri A, Meyer N, Jacqmin D, Lang H: Prognostic value of renal vein and inferior vena cava involvement in renal cell carcinoma. Eur Urol 2009;55:452-459.
21.
Zhang JP, Zhu Y, Liu YJ, Zhang L, Sun LA, Guo JM, Lin ZM: Temporary filters and liver mobilization technique improve the safety and prognosis of radical nephrectomy and inferior vena cava thrombectomy in renal cell carcinoma with subdiaphragmatic thrombosis. Urol Int 2013;91:279-284.
22.
Naitoh J, Kaplan A, Dorey F, Figlin R, Belldegrun A: 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 Urol 1999;162:46-50.
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2017
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