Renal cell carcinoma with thrombus in the inferior vena cava: analysis of survival and prognostic factors in a tertiary hospital
DOI:
https://doi.org/10.48193/g62pj334Keywords:
Renal cell carcinoma, Tumor thrombus, Inferior vena cava, Nephrectomy, Thrombectomy, Extracorporeal circulation, Survival, Prognostic factorsAbstract
Introduction and objectives: renal cell carcinoma (RCC) with tumor extension to the inferior vena cava (IVC) presents an oncological surgical challenge. The aim of this study was to analyze perioperative outcomes, overall survival (OS), and associated prognostic factors in patients undergoing surgery at a tertiary center.
Methods: retrospective study of 34 patients diagnosed between 2001 and 2024, all of whom underwent radical nephrectomy and thrombectomy. Preoperative evaluation was performed using computed tomography (CT) and magnetic resonance imaging (MRI). Clinical, surgical, and survival variables were analyzed using descriptive methods and univariate and multivariate Cox regression models.
Results: the mean age at diagnosis was 61.9 ± 8.7 years. The thrombus was classified as level I (23.5 %), II (35.3 %), III (26.5 %), and IV (14.7 %) according to Neves and Zincke. Surgery was performed with curative intent in 91.2 % of cases and cytoreductive intent in 8.8 %. Cardiopulmonary bypass was required in 20.6 %. In multivariate analysis, the need for cardiopulmonary bypass (HR = 0.24; 95 % CI: 0.09–0.66; p = 0.005) and lymph node involvement (HR = 0.33; 95 % CI: 0.11–0.96; p = 0.042) were identified as factors associated with a worse prognosis.
Conclusions: colorectal cancer with thrombus in the inferior vena cava presents a surgical challenge. Lymph node involvement and the need for cardiopulmonary bypass are associated with lower survival. Adequate preoperative evaluation and multidisciplinary management are essential to optimize oncological and surgical outcomes.
References
Ljungberg B, Albiges L, Abu-Ghanem Y, Bedke J, Capitanio U, Dabestani S, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 Update. European Urology. 2022;82(4): 399–410. https://doi.org/10.1016/j.eururo.2022.03.006.
Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU international. 2004;94(1): 33–41. https://doi.org/10.1111/j.1464-410X.2004.04897.x.
Jiménez-Romero C, Conde M, de la Rosa F, Manrique A, Calvo J, Caso Ó, et al. Tratamiento de la trombosis de vena cava inferior asociada a los tumores renales. Cirugía Española. 2017;95(3): 152–159. https://doi.org/10.1016/j.ciresp.2017.01.004.
Torres LN, Ciancio G. Liver transplant techniques used in the management of clear renal cell carcinoma with thrombi in the inferior vena cava that ascend to the diaphragm: case series. Revista Colombiana de Cirugía. 2019;34(4): 405–406.
Neves RJ, Zincke H. Surgical treatment of renal cancer with vena cava extension. British Journal of Urology. 1987;59(5): 390–395. https://doi.org/10.1111/j.1464-410x.1987.tb04832.x.
Denardi F, Oliveira Reis L, Oliveira RRM, Ferreira F, Ferreira U. Tumor renal con trombo en la vena cava inferior: Manejo quirúrgico y pronóstico. Actas Urológicas Españolas. 2009;33(4): 372–377.
Haddad AQ, Wood CG, Abel EJ, Krabbe LM, Darwish OM, Thompson RH, et al. Oncologic outcomes following surgical resection of renal cell carcinoma with inferior vena caval thrombus extending above the hepatic veins: a contemporary multicenter cohort. The Journal of Urology. 2014;192(4): 1050–1056. https://doi.org/10.1016/j.juro.2014.03.111.
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