TY - JOUR
T1 - Multi-disciplinary surgical approach to the management of patients with renal cell carcinoma with venous tumor thrombus
T2 - 15 year experience and lessons learned
AU - Gayed, Bishoy A.
AU - Youssef, Ramy
AU - Darwish, Oussama
AU - Kapur, Payal
AU - Bagrodia, Aditya
AU - Brugarolas, James B
AU - Raj, Ganesh
AU - Dimaio, J. Michael
AU - Sagalowsky, Arthur I
AU - Margulis, Vitaly
N1 - Publisher Copyright:
© 2016 The Author(s).
PY - 2016/7/19
Y1 - 2016/7/19
N2 - Background: The management of patients with renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is challenging. We report our 15 year experience in the management of patients with RCC with VTT utilizing a multidisciplinary team approach, highlighting improved total and specifically Clavien III-V complication rates. Methods: We reviewed the records of 146 consecutive patients who underwent radical nephrectomy with venous thrombectomy between 1998 and 2012. Data on patient history, staging, surgical techniques, morbidity, and survival were analyzed. Additionally, complication rates between two surgical eras, 1998-2006 and 2006-2012, were assessed. Results: The study included 146 patients, 97 males (66 %), and a median age of 61 years (range, 24-83). Overall complications rate was 53 %, high grade complications (Clavien III -V) occurred in 10 % of patients. Most importantly, there was a lower incidence of overall and high grade complications (45 % and 8 %, respectively) in the last 6 years compared to the earlier surgeries included in the study (67 % and 13 % respectively) [p =.008 and.03, respectively). 30 day postoperative mortality was 2.7 %. 5 year overall survival (5Y- OS) and 5 year cancer specific survival (5Y- CSS) were 51 % and 40 %, respectively. Metastasis was the only independent predictor factor for CSS (HR 3.8, CI 1.9-7.6 and p <.001) and OS (HR 2.6, CI 1.5-4.7 and p =.001) in all patients. Conclusions: Our data suggest that patients with RCC and VTT can be treated safely utilizing a multidisciplinary team approach leading to a decrease in complication rates.
AB - Background: The management of patients with renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is challenging. We report our 15 year experience in the management of patients with RCC with VTT utilizing a multidisciplinary team approach, highlighting improved total and specifically Clavien III-V complication rates. Methods: We reviewed the records of 146 consecutive patients who underwent radical nephrectomy with venous thrombectomy between 1998 and 2012. Data on patient history, staging, surgical techniques, morbidity, and survival were analyzed. Additionally, complication rates between two surgical eras, 1998-2006 and 2006-2012, were assessed. Results: The study included 146 patients, 97 males (66 %), and a median age of 61 years (range, 24-83). Overall complications rate was 53 %, high grade complications (Clavien III -V) occurred in 10 % of patients. Most importantly, there was a lower incidence of overall and high grade complications (45 % and 8 %, respectively) in the last 6 years compared to the earlier surgeries included in the study (67 % and 13 % respectively) [p =.008 and.03, respectively). 30 day postoperative mortality was 2.7 %. 5 year overall survival (5Y- OS) and 5 year cancer specific survival (5Y- CSS) were 51 % and 40 %, respectively. Metastasis was the only independent predictor factor for CSS (HR 3.8, CI 1.9-7.6 and p <.001) and OS (HR 2.6, CI 1.5-4.7 and p =.001) in all patients. Conclusions: Our data suggest that patients with RCC and VTT can be treated safely utilizing a multidisciplinary team approach leading to a decrease in complication rates.
KW - IVC thrombus
KW - Outcomes
KW - Renal cell carcinoma
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U2 - 10.1186/s12894-016-0157-3
DO - 10.1186/s12894-016-0157-3
M3 - Article
C2 - 27435269
AN - SCOPUS:84978705079
SN - 1471-2490
VL - 16
JO - BMC Urology
JF - BMC Urology
IS - 1
M1 - 43
ER -