Surgical management of renal neoplasm extending into the inferior veno cava
10.3760/cma.j.issn.1000-6702.2017.01.003
- VernacularTitle:肾肿瘤合并下腔静脉瘤栓的外科处理——115例回顾性分析
- Author:
Xuren XIAO
;
Xianglong CHEN
;
Hongjiang ZHU
;
Yongzhong JIA
;
Xuejie WU
;
Dong PANG
;
Qingjiang ZHANG
;
Hua WANG
;
Lixing WANG
;
Qi WANG
;
Lei ZHANG
;
Linyang YE
;
Baofa HONG
;
Wei CAI
;
Jiangping GAO
;
Yong YANG
;
Maoqiang WANG
;
Changqing GAO
;
Liang CUI
- Keywords:
Kidney tumor;
Renal cell carcinoma;
Tumor thrombus in inferior vena cava;
Caval thrombectomy
- From:
Chinese Journal of Urology
2017;38(1):9-14
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize our experience with surgical management of renal neoplasm involving inferoir veno cava.Methods We review the data of 115 patients,including 74 male patients and 41 female patients,with renal neoplasm involving venous system between March 1993 and December 2015.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.There were 15 patients (13.0％) with renal vein thrombus,38 (33.1％) with infrahepatic thrombus,29 (25.2％) with low retrohepatic thrombus,20 (17.4％) with high retrohepatic thrombus,and 13 (11.3％) with supradiaphragmatic thrombus.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.All patients accepted the radical nephrectomy.Primary outcomes were overall survival (OS),and cancer special survival (CSS) in patients with renal cell carcinoma (RCC) estimated by Kaplan-Meier method.Secondary outcome included operative and oncological features,past-operative complications and hospital mortality.Cox proportional hazard model was used to univariate and multivariate analysis for risk factor impacting on OS of RCC patients.Results Complete resections of renal neoplasm with tumor thrombus were achieved in 113 patients (98.3％),2 patients died intraoperatively due to the dropping of thrombus.Postoperative complication rate was 16.8％.Hospital mortality was 2.6％.Mean follow-up interval was 48 months.OS rates at 5-,and 10-year in RCC patients were 66.5％,and 61.8％,respectively.Metastasis was an independent risk factor affecting on OS (P =0.000).However,the level of thrombus was not an risk factor affecting the prognosis.Conclusions Radical resection of renal tumor and caval thrombus is an effective treatment for prolonging survival in patients with RCC extending into venous system.Retrohepatic caval tumor thrombus below or above the main hepatic vein should be dichotomized and managed respectively with diverse techniques.Metastatic rather than the level of thrombus was a risk factor impacting on RCC patient survival.
