Long-term Survival in Patients Undergoing Radical Nephrectomy and Inferior Vena Cava Thrombectomy

Single-Center Experience

Gaetano Ciancio, Murugesan Manoharan, Devendar Katkoori, Rosely De Los Santos, Mark S. Soloway

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Background: Renal cell carcinoma (RCC) with a tumor thrombus extension into the inferior vena cava (IVC) demands aggressive surgical management. Objective: To evaluate the long-term survival in patients undergoing radical nephrectomy and IVC thrombectomy. Design, setting, and participants: We performed a retrospective analysis of 87 patients undergoing surgery between 1997 and 2008. The patients were grouped according to the extent of tumor thrombus, with level I involving the IVC at the level of the renal vein, level II being infrahepatic IVC, level III being intrahepatic IVC, and level IV being suprahepatic IVC or right atrium. Relevant clinical and pathologic data were analyzed. Measurements: Disease-free survival (DFS) and disease-specific survival (DSS) were studied. Results and limitations: The median follow-up was 22 mo, and 19, 14, 40, and 14 patients had level I, II, III, and IV IVC thrombus, respectively. Among patients with M0 disease, 22 developed metastases. The 5-yr DFS was 64% for all levels and 74%, 69.5%, 59.5%, and 58% for levels I, II, III, and IV, respectively. Of the level I group, 16% of patients died of disease compared to 57% of the level IV group. The 5-yr DSS for all levels was 46% and 71%, 48%, 40%, and 35% for levels I, II, III, and IV, respectively. Patients with level IV thrombus had a significantly lower 5-yr DSS compared to level I (p = 0.03). However, when analyzed in two groups-supradiaphragmatic and infradiaphragmatic-there was no significant difference in DSS (P = 0.14). On univariate analysis, metastasis at presentation, non-clear-cell histology, lymph node metastases, and higher nuclear grade were statistically significant prognostic factors influencing DSS. Only higher nuclear grade (p = 0.03), metastasis at presentation (p < 0.01), and non-clear-cell histology (p = 0.03) were independent prognostic factors on multivariate analysis. Conclusions: Radical nephrectomy and IVC thrombectomy offer reasonable long-term survival. The level of tumor thrombus is not an independent prognostic factor. Distant metastasis at presentation, higher nuclear grade, and non-clear-clear cell histology are significant prognostic factors influencing DSS.

Original languageEnglish
Pages (from-to)667-672
Number of pages6
JournalEuropean Urology
Volume57
Issue number4
DOIs
StatePublished - Apr 1 2010

Fingerprint

Thrombectomy
Inferior Vena Cava
Nephrectomy
Survival
Thrombosis
Neoplasm Metastasis
Histology
Disease-Free Survival
Neoplasms
Renal Veins
Heart Atria
Renal Cell Carcinoma
Multivariate Analysis
Lymph Nodes

Keywords

  • Inferior vena cava
  • Long term
  • Radical nephrectomy
  • Survival
  • Thrombectomy

ASJC Scopus subject areas

  • Urology

Cite this

Long-term Survival in Patients Undergoing Radical Nephrectomy and Inferior Vena Cava Thrombectomy : Single-Center Experience. / Ciancio, Gaetano; Manoharan, Murugesan; Katkoori, Devendar; De Los Santos, Rosely; Soloway, Mark S.

In: European Urology, Vol. 57, No. 4, 01.04.2010, p. 667-672.

Research output: Contribution to journalArticle

Ciancio, Gaetano ; Manoharan, Murugesan ; Katkoori, Devendar ; De Los Santos, Rosely ; Soloway, Mark S. / Long-term Survival in Patients Undergoing Radical Nephrectomy and Inferior Vena Cava Thrombectomy : Single-Center Experience. In: European Urology. 2010 ; Vol. 57, No. 4. pp. 667-672.
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abstract = "Background: Renal cell carcinoma (RCC) with a tumor thrombus extension into the inferior vena cava (IVC) demands aggressive surgical management. Objective: To evaluate the long-term survival in patients undergoing radical nephrectomy and IVC thrombectomy. Design, setting, and participants: We performed a retrospective analysis of 87 patients undergoing surgery between 1997 and 2008. The patients were grouped according to the extent of tumor thrombus, with level I involving the IVC at the level of the renal vein, level II being infrahepatic IVC, level III being intrahepatic IVC, and level IV being suprahepatic IVC or right atrium. Relevant clinical and pathologic data were analyzed. Measurements: Disease-free survival (DFS) and disease-specific survival (DSS) were studied. Results and limitations: The median follow-up was 22 mo, and 19, 14, 40, and 14 patients had level I, II, III, and IV IVC thrombus, respectively. Among patients with M0 disease, 22 developed metastases. The 5-yr DFS was 64{\%} for all levels and 74{\%}, 69.5{\%}, 59.5{\%}, and 58{\%} for levels I, II, III, and IV, respectively. Of the level I group, 16{\%} of patients died of disease compared to 57{\%} of the level IV group. The 5-yr DSS for all levels was 46{\%} and 71{\%}, 48{\%}, 40{\%}, and 35{\%} for levels I, II, III, and IV, respectively. Patients with level IV thrombus had a significantly lower 5-yr DSS compared to level I (p = 0.03). However, when analyzed in two groups-supradiaphragmatic and infradiaphragmatic-there was no significant difference in DSS (P = 0.14). On univariate analysis, metastasis at presentation, non-clear-cell histology, lymph node metastases, and higher nuclear grade were statistically significant prognostic factors influencing DSS. Only higher nuclear grade (p = 0.03), metastasis at presentation (p < 0.01), and non-clear-cell histology (p = 0.03) were independent prognostic factors on multivariate analysis. Conclusions: Radical nephrectomy and IVC thrombectomy offer reasonable long-term survival. The level of tumor thrombus is not an independent prognostic factor. Distant metastasis at presentation, higher nuclear grade, and non-clear-clear cell histology are significant prognostic factors influencing DSS.",
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T2 - Single-Center Experience

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AU - Manoharan, Murugesan

AU - Katkoori, Devendar

AU - De Los Santos, Rosely

AU - Soloway, Mark S.

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N2 - Background: Renal cell carcinoma (RCC) with a tumor thrombus extension into the inferior vena cava (IVC) demands aggressive surgical management. Objective: To evaluate the long-term survival in patients undergoing radical nephrectomy and IVC thrombectomy. Design, setting, and participants: We performed a retrospective analysis of 87 patients undergoing surgery between 1997 and 2008. The patients were grouped according to the extent of tumor thrombus, with level I involving the IVC at the level of the renal vein, level II being infrahepatic IVC, level III being intrahepatic IVC, and level IV being suprahepatic IVC or right atrium. Relevant clinical and pathologic data were analyzed. Measurements: Disease-free survival (DFS) and disease-specific survival (DSS) were studied. Results and limitations: The median follow-up was 22 mo, and 19, 14, 40, and 14 patients had level I, II, III, and IV IVC thrombus, respectively. Among patients with M0 disease, 22 developed metastases. The 5-yr DFS was 64% for all levels and 74%, 69.5%, 59.5%, and 58% for levels I, II, III, and IV, respectively. Of the level I group, 16% of patients died of disease compared to 57% of the level IV group. The 5-yr DSS for all levels was 46% and 71%, 48%, 40%, and 35% for levels I, II, III, and IV, respectively. Patients with level IV thrombus had a significantly lower 5-yr DSS compared to level I (p = 0.03). However, when analyzed in two groups-supradiaphragmatic and infradiaphragmatic-there was no significant difference in DSS (P = 0.14). On univariate analysis, metastasis at presentation, non-clear-cell histology, lymph node metastases, and higher nuclear grade were statistically significant prognostic factors influencing DSS. Only higher nuclear grade (p = 0.03), metastasis at presentation (p < 0.01), and non-clear-cell histology (p = 0.03) were independent prognostic factors on multivariate analysis. Conclusions: Radical nephrectomy and IVC thrombectomy offer reasonable long-term survival. The level of tumor thrombus is not an independent prognostic factor. Distant metastasis at presentation, higher nuclear grade, and non-clear-clear cell histology are significant prognostic factors influencing DSS.

AB - Background: Renal cell carcinoma (RCC) with a tumor thrombus extension into the inferior vena cava (IVC) demands aggressive surgical management. Objective: To evaluate the long-term survival in patients undergoing radical nephrectomy and IVC thrombectomy. Design, setting, and participants: We performed a retrospective analysis of 87 patients undergoing surgery between 1997 and 2008. The patients were grouped according to the extent of tumor thrombus, with level I involving the IVC at the level of the renal vein, level II being infrahepatic IVC, level III being intrahepatic IVC, and level IV being suprahepatic IVC or right atrium. Relevant clinical and pathologic data were analyzed. Measurements: Disease-free survival (DFS) and disease-specific survival (DSS) were studied. Results and limitations: The median follow-up was 22 mo, and 19, 14, 40, and 14 patients had level I, II, III, and IV IVC thrombus, respectively. Among patients with M0 disease, 22 developed metastases. The 5-yr DFS was 64% for all levels and 74%, 69.5%, 59.5%, and 58% for levels I, II, III, and IV, respectively. Of the level I group, 16% of patients died of disease compared to 57% of the level IV group. The 5-yr DSS for all levels was 46% and 71%, 48%, 40%, and 35% for levels I, II, III, and IV, respectively. Patients with level IV thrombus had a significantly lower 5-yr DSS compared to level I (p = 0.03). However, when analyzed in two groups-supradiaphragmatic and infradiaphragmatic-there was no significant difference in DSS (P = 0.14). On univariate analysis, metastasis at presentation, non-clear-cell histology, lymph node metastases, and higher nuclear grade were statistically significant prognostic factors influencing DSS. Only higher nuclear grade (p = 0.03), metastasis at presentation (p < 0.01), and non-clear-cell histology (p = 0.03) were independent prognostic factors on multivariate analysis. Conclusions: Radical nephrectomy and IVC thrombectomy offer reasonable long-term survival. The level of tumor thrombus is not an independent prognostic factor. Distant metastasis at presentation, higher nuclear grade, and non-clear-clear cell histology are significant prognostic factors influencing DSS.

KW - Inferior vena cava

KW - Long term

KW - Radical nephrectomy

KW - Survival

KW - Thrombectomy

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