Perioperative and oncologic outcome in patients treated for renal cell carcinoma with an extended inferior vena cava tumour thrombus level II-IV

Abstract

Purpose Surgical treatment of patients with renal cell carcinoma (RCC) and an extended tumour thrombus (TT) in the inferior vena cava (IVC) is challenging and often requires a multidisciplinary approach. The aim of this study was to analyse results in the real-world management of RCC patients with an extended IVC TT (level II-IV according to the Mayo classification of macroscopic venous invasion in RCC) in terms of pre-, peri- and postoperative outcome, complications and oncologic outcome.

Methods We investigated 61 patients with evidence of RCC and an extended TT in the IVC undergoing radical nephrectomy and tumour thrombectomy at our tertiary referral centre. Patients and operative characteristics were recorded and complications were analysed using the Clavien-Dindo classification. Follow-up data were retrieved by contacting the treating outpatient urologists, general practitioners and patients.

Results The TT level was II in 36, III in 8 and IV in 17 patients. Complications grade IIIb and higher according to the Clavien-Dindo classification occurred in n = 3 (8.4 %), n = 2 (25.0 %) and n = 5 (29.5 %) patients with level II, III and IV TT, respectively. The overall survival of patients with TT level II, III and IV at 24 months (60 months) was 66.9 % (41.6 %), 83.3 % (83.3 %) and 64.1 % (51.3 %). Presence of primary metastatic disease was the only significant independent predictor for OS. 

Conclusions Radical nephrectomy with tumour thrombectomy appears to be a feasible and effective treatment option in the management of patients with RCC and an extended IVC TT.

Zusammenfassung

Einleitung Die Behandlung von Patienten mit Nierenzellkarzinom (NZK) und extendiertem Tumorthrombus (TT) der Vena cava inferior (VCI) stellt eine Herausforderung dar und erfordert häufig ein multidisziplinäres Vorgehen. Das Ziel dieser Studie war es, die Behandlung von Patienten mit NZK und extendiertem VCI-TT (Level II–IV, gemäß der Mayo-Klassifikation) im Hinblick auf prä-, peri- und postoperative Ergebnisse, Komplikationen und onkologischem Ergebnis zu analysieren.

Methoden In einer retrospektiven Studie wurden 61 Patienten mit bildmorphologischem Nachweis eines NZK und TT (Level II-IV) in der VCI, die an unserem Zentrum einer radikalen Nephrektomie und Tumorthrombektomie unterzogen wurden, eingeschlossen. Prä-, peri-, und postoperative Parameter wurden erhoben und Komplikationen anhand der Clavien-Dindo-Klassifikation analysiert. Das Follow-up der Patienten wurde durch Kontaktaufnahme mit den behandelnden Urologen, Allgemeinärzten und Patienten durchgeführt.

Ergebnisse Das TT-Level betrug II bei 36, III bei 8 und IV bei 17 Patienten. Grad IIIb und höhere Komplikationen gemäß der Clavien-Dindo-Klassifikation traten bei 3 (8,4 %) mit TT Level II, 2 (25,0 %) mit TT Level III und 5 (29,5 %) Patienten mit TT Level IV auf. Das Gesamtüberleben für Patienten mit TT-Level II, III und IV nach 24 Monaten (60 Monaten) betrug 66,9 % (41,6 %), 83,3 % (83,3 %) und 64,1 % (51,3 %). Das Vorliegen einer primären metastasierten Erkrankung war der einzige signifikante unabhängige Prädiktor für das Gesamtüberleben.

Schlussfolgerung Die radikale Nephrektomie mit Tumorthrombektomie scheint eine praktikable und wirksame Behandlungsoption bei der Behandlung von Patienten mit NZK und extendiertem VCI-TT zu sein.

Keywords

RCC - renal cell carcinoma - IVC - inferior vena cava - tumour thrombus

Schlüsselwörter

Nierenzellkarzinom - Cavazapfen - Operative Therapie

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