Year : 2021 | Volume
: 37 | Issue : 3 | Page : 234--240
Experience with management of renal cell carcinoma with inferior vena cava/right atrial tumor thrombus
Shitangsu Kakoti1, Rahul Jena1, Sanjoy Kumar Sureka1, Aneesh Srivastava1, Anil Mandhani2, Uday Pratap Singh1
1 Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Urology and Renal Transplant, Fortis Memorial Research Institute, Gurugram, Haryana, India
Introduction: We aimed to present our experience in managing renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus.
Methods: Records of all patients aged 18 years and older, with a diagnosis of primary renal masses with IVC thrombus, presenting to our institute from January 2012 to August 2020 were retrospectively reviewed. Patients with tumor thrombus limited only to renal vein were excluded from the analysis. Their hospital course and outcomes were recorded and evaluated for predictors of survival.
Results: During the study period, we treated 61 patients with a renal mass and concurrent IVC thrombus and 56 of these underwent surgery. 7 of them had level III and 6 had level IV thrombus. A total of six patients received neoadjuvant tyrosine kinase inhibitor (TKI) therapy and all of them showed a decrease in size and level of tumor thrombus and cardiopulmonary bypass was safely avoided. Fourteen patients had distant metastasis and underwent cytoreductive surgery and of these 12 patients received TKI therapy after surgery with a mean survival of 26.8 months. The overall survival at 2 and 5 years of nonmetastatic group was 81.1% and 47.5% respectively and in metastatic group was 35.1% and 0%, respectively. Poor performance status, distant metastasis, higher T stage, higher thrombus levels, and positive surgical margins were all predictors of decreased survival.
Conclusions: Complete surgical resection in both nonmetastatic and metastatic RCC with IVC thrombus has long-term survival benefits. Neoadjuvant TKI therapy, with adequate preoperative planning, helps in decreasing the size of the thrombus and in safely avoiding bypass in level III and IV IVC thrombi.
Uday Pratap Singh
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
|How to cite this article:|
Kakoti S, Jena R, Sureka SK, Srivastava A, Mandhani A, Singh UP. Experience with management of renal cell carcinoma with inferior vena cava/right atrial tumor thrombus.Indian J Urol 2021;37:234-240
|How to cite this URL:|
Kakoti S, Jena R, Sureka SK, Srivastava A, Mandhani A, Singh UP. Experience with management of renal cell carcinoma with inferior vena cava/right atrial tumor thrombus. Indian J Urol [serial online] 2021 [cited 2022 Jun 30 ];37:234-240
Available from: https://www.indianjurol.com/article.asp?issn=0970-1591;year=2021;volume=37;issue=3;spage=234;epage=240;aulast=Kakoti;type=0