IMPORTANT SURGICAL CONSIDERATIONS IN THE MANAGEMENT OF RENAL CELL CARCINOMA (RCC) WITH INFERIOR VENA CAVA (IVC) TUMOUR THROMBUS

What's known on the subject? and What does the study add? Historically, the surgical management of renal tumours with intravascular tumour thrombus has been associated with high morbidity and mortality. In addition, few cases are treated, and typically at tertiary care referral centres, hence l...

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Published in:BJU international 2012-10, Vol.110 (7), p.E327-E328
Main Authors: Joshi, Shivam, Ayyathurai, Rajinikanth, Satyanarayana, Ramgopal, Ciancio, Gaetano
Format: Article
Language:English
Subjects:
Anesthesia - methods
Biological and medical sciences
Blood Vessel Prosthesis Implantation - methods
Carcinoma, Renal Cell - pathology
Carcinoma, Renal Cell - surgery
Diagnostic Imaging - methods
Humans
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
Kidneys
Medical sciences
Neoplasm Staging - methods
Neoplastic Cells, Circulating - pathology
Nephrology. Urinary tract diseases
Patient Care Team
Preoperative Care - methods
Treatment Outcome
Tumors of the urinary system
Vena Cava, Inferior - pathology
Venous Thrombosis - surgery
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Summary:What's known on the subject? and What does the study add? Historically, the surgical management of renal tumours with intravascular tumour thrombus has been associated with high morbidity and mortality. In addition, few cases are treated, and typically at tertiary care referral centres, hence little is known and published about the ideal surgical management of such complex cases. The present comprehensive review details how a multidisciplinary surgical approach to renal tumours with intravascular tumour thrombus can optimise patient outcomes. Similarly, we have developed a treatment algorithm in this review that can be used in the surgical planning of such cases. To detail the perioperative and technical considerations essential to the surgical management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumour thrombus, as historically patients with RCC and IVC tumour thrombus have had an adverse clinical outcome. • Recent surgical and perioperative advances have for the most part optimized the clinical outcome of such patients. A comprehensive review of the scientific literature was conducted using MEDLINE from 1990 to present using as the keywords 'renal cell carcinoma' and 'IVC tumor thrombus'. • In all, 62 manuscripts were reviewed, 58 of which were in English. Of these, 25 peer-reviewed articles were deemed of scientific merit and were assessed in detail as part of this comprehensive review. • These articles consist of medium to large (≥25 patients) peer-reviewed studies containing contemporary data pertaining to the surgical management of RCC and IVC tumour thrombus. • Many of these studies highlight important surgical techniques and considerations in the management of such patients and report on their respective clinical outcomes. Careful preoperative planning is essential to optimising the outcomes within this patient cohort. High quality and detailed preoperative imaging studies help delineate the proximal extension of the IVC tumour thrombus and possible caval wall direct invasion while determining the potential necessity for intraoperative vascular bypass. • The surgical management of RCC and IVC tumour thrombus (particularly for level III or IV) often requires the commitment of a multidisciplinary surgical team to optimise patient surgical outcomes. • Despite significant improvements in surgical techniques and perioperative care, the 5-year overall survival remains only between 32% and 69%, highlighting the adverse prognosis of such
ISSN:1464-4096
1464-410X
DOI:10.1111/j.1464-410X.2012.10975_1.x