Multi-disciplinary surgical approach to the management of patients with renal cell carcinoma with venous tumor thrombus

15 year experience and lessons learned

Bishoy A. Gayed, Ramy Youssef, Oussama Darwish, Payal Kapur, Aditya Bagrodia, James B Brugarolas, Ganesh Raj, J. Michael Dimaio, Arthur I Sagalowsky, Vitaly Margulis

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Abstract

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.

Original languageEnglish (US)
Article number43
JournalBMC Urology
Volume16
Issue number1
DOIs
StatePublished - Jul 19 2016

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Renal Cell Carcinoma
Thrombosis
Neoplasms
Survival
Thrombectomy
Nephrectomy
Neoplasm Metastasis
Morbidity
Mortality
Incidence

Keywords

  • IVC thrombus
  • Outcomes
  • Renal cell carcinoma

ASJC Scopus subject areas

  • Reproductive Medicine
  • Urology

Cite this

@article{945abfdfad7344e3a1390fb6c826c849,
title = "Multi-disciplinary surgical approach to the management of patients with renal cell carcinoma with venous tumor thrombus: 15 year experience and lessons learned",
abstract = "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.",
keywords = "IVC thrombus, Outcomes, Renal cell carcinoma",
author = "Gayed, {Bishoy A.} and Ramy Youssef and Oussama Darwish and Payal Kapur and Aditya Bagrodia and Brugarolas, {James B} and Ganesh Raj and Dimaio, {J. Michael} and Sagalowsky, {Arthur I} and Vitaly Margulis",
year = "2016",
month = "7",
day = "19",
doi = "10.1186/s12894-016-0157-3",
language = "English (US)",
volume = "16",
journal = "BMC Urology",
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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

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

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VL - 16

JO - BMC Urology

JF - BMC Urology

SN - 1471-2490

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