Surgical treatment for patients with renal cell carcinoma and venous thrombosis
Daohu Wang, Chengqiang Mo, Shuangjian Jiang, Wei Chen, Lingwu Chen, Junxing Chen, Shaopeng Qiu
Published 2015-09-15
Cite as Chin J Urol, 2015, 36(9): 665-668. DOI: 10.3760/cma.j.issn.1000-6702.2015.09.008
Abstract
ObjectiveTo investigate the efficacy and safety of radical nephrectomy associated with venous thrombectomy and the role of preoperative angioembolization.
MethodsFrom Sep 2006 to Dec 2014, the data from 15 cases with renal cell carcinoma and venous tumor thrombus were collected and analyzed retrospectively.The 15 patients included 8 men and 7 women, whose age ranged from 16 to 75 years.Before operation, all patients underwent imaging examinations which demonstrated the renal tumor and venous thrombus.The tumors size ranged from 5.4 to 14.5 cm.The levels of venous thrombus included 0 grade in 4 cases, Ⅰgrade in 2 cases, Ⅱgrade in 6 cases and Ⅲ grade in 3 cases.The 15 patients were divided into angioembolization group (n=5) and non–angioembolization group (n=10) according to the conduction of preoperative angioembolization.
ResultsAll cases successful accepted the nephrectomy.The venous thrombectomy were undergone in 14 cases except for one case due to the severe adhesion between renal vein and aorta.The average operative time was 243.3±77.0 min.The mean blood loss was 1 373.3±1 440.9 ml and the volume of blood transfusion was 533.3±521.9 ml.The average time of postoperative hospital stay was 12.7±5.2 days.Symptomatic tumor thrombus embolism didn't occur in all cases, perioperatively.There were no significant difference between these two groups in operative time, blood loss, blood transfusion volume and postoperative hospital stay (P>0.05). Eight cases were followed up with a period of 6 to 69 months.Four cases had disease–free survival during follow up.Two cases died at 30 and 55 months after surgery, respectively.One had tumor recurrence at 6 months after surgery.One patient accepted a 6–months target therapy (sunitinib) before surgery.However, his thrombus could not be removed during the operation.After the operation, he continued to choose the target drug therapy for 18 months.No progression for thrombosis or metastasis has been found.
ConclusionsNephrectomy and venous thrombectomy could be safe and effective for renal cell carcinoma associated with venous thrombosis.Preoperative angioembolization could not reduce the perioperative risk such as blood loss.
Key words:
Carcinoma, renal cell; Nephrectomy; Thrombectomy; Angioembolization
Contributor Information
Daohu Wang
Department of Urology, First Affiliated Hospital, Sun Yat–sen University, Guangzhou 510080, China
Chengqiang Mo
Shuangjian Jiang
Wei Chen
Lingwu Chen
Junxing Chen
Shaopeng Qiu