IVC Thrombectomy in Renal Cell Carcinoma—Analysis

Authors: Jagdeesh Kulkarni Yogesh Jadhav Rohan S Valsangkar

Publish Date: 2011/12/20

Volume: 3, Issue: 2, Pages: 107-113

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Abstract

To review our experience of RCC with IVC thrombus in terms of clinical presentation principles of surgical management in contemporary era also an impact of clinicopathological factors on prognosis Total 100 patients who underwent radical nephrectomy and IVC thrombectomy between 1991–2008 were included in this retrospective analysis Data was analysed in terms of clinical pathological factors survivals and compared with contemporary literature The extent tumour thrombus was infrahepatic in 58 retro hepatic in 28 and suprahepatic in 14 patients including 6 with right atrial thrombus The immediate postoperative mortality was 2 and incidence of major postoperative non fatal complications was 38 which were managed conservatively The overall and disease free 5 year survival was 63 and 55 Further amongst the histological types patients with clear cell tumours had the best DFS 7142 and those with papillary had the poor DFS 3076 outcome Grade II tumors had better survivals as compared to grade IV DFS 7539 vs 2352 p  005 Loco regional extent wise 74 patients without perinephric fat invasion were free from disease at 5 years as compared to 30 of those who had perinephric fat invasion p  001 Similarly 5 year DFS was 7611 in patients with negative nodes as compared to 12 in positive nodes p  001 In conclusion radical nephrectomy with IVC thrombectomy still remains the most effective therapeutic option in management in this clinical setting Although this is complicated surgery success with multi disciplinary approach excellent survival outcome can be obtained Further pathological factors such as locoregional spread and grade of tumor rather than clinical factors influence long term survival

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