Radical nephrectomy with vena caval thrombectomy: A contemporary experience

Matthew G. Kaag, Christien Toyen, Paul Russo, Angel Cronin, R. Houston Thompson, Jeffrey Schiff, Melanie Bernstein, Manjit Bains

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Renal tumours with caval thrombus are relatively rare. Surgical management is the standard of care for lesions of this nature. Small series have been published by other groups, but our understanding of the optimal management continues to evolve. We present the Memorial Sloan-Kettering Cancer Center series, with a discussion of techniques and complications. Of interest, we include several patients with high-level caval thrombi which were managed without bypass, supporting previous publications by the group from University of Miami. Objective: To report on the contemporary Memorial Sloan-Kettering Cancer Center experience with radical nephrectomy and vena caval thrombectomy. Patients and methods: Patients who underwent radical nephrectomy and vena caval thrombectomy without the use of bypass techniques were retrospectively identified. Data were collected on intraoperative and pathological findings as well as postoperative complications and oncological outcomes. Results: In all, 78 patients underwent radical nephrectomy with off-bypass resection of vena caval thrombus between 1989 and 2009. The median (interquartile range, IQR) operation duration was 293 (226-370) min, and median (IQR) blood loss was 1300 (750-2500) mL. In all, 10 patients (13%) were confirmed to have intra- or supra-hepatic tumour thrombus (level 3/4), eight of whom required supra-hepatic control of the inferior vena cava (IVC). Major (grade 3-5) postoperative complications occurred in 14 (18%), with five postoperative deaths. Disease recurred in 27/62 patients who were considered completely resected at surgery and had adequate follow-up. The overall 5-year survival (95% confidence interval) probability was 48% (35-60%). Conclusions: Radical nephrectomy with vena caval thrombectomy is associated with acceptable postoperative morbidity and mortality, and long-term survival is possible in some patients. Many level 3/4 thrombi could be safely approached without the use of bypass techniques.

Original languageEnglish (US)
Pages (from-to)1386-1393
Number of pages8
JournalBJU International
Volume107
Issue number9
DOIs
StatePublished - May 1 2011

Fingerprint

Thrombectomy
Venae Cavae
Nephrectomy
Thrombosis
Liver
Neoplasms
Survival
Inferior Vena Cava
Standard of Care
Confidence Intervals
Morbidity
Kidney
Mortality

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Kaag, M. G., Toyen, C., Russo, P., Cronin, A., Thompson, R. H., Schiff, J., ... Bains, M. (2011). Radical nephrectomy with vena caval thrombectomy: A contemporary experience. BJU International, 107(9), 1386-1393. https://doi.org/10.1111/j.1464-410X.2010.09661.x
Kaag, Matthew G. ; Toyen, Christien ; Russo, Paul ; Cronin, Angel ; Thompson, R. Houston ; Schiff, Jeffrey ; Bernstein, Melanie ; Bains, Manjit. / Radical nephrectomy with vena caval thrombectomy : A contemporary experience. In: BJU International. 2011 ; Vol. 107, No. 9. pp. 1386-1393.
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Kaag, MG, Toyen, C, Russo, P, Cronin, A, Thompson, RH, Schiff, J, Bernstein, M & Bains, M 2011, 'Radical nephrectomy with vena caval thrombectomy: A contemporary experience', BJU International, vol. 107, no. 9, pp. 1386-1393. https://doi.org/10.1111/j.1464-410X.2010.09661.x

Radical nephrectomy with vena caval thrombectomy : A contemporary experience. / Kaag, Matthew G.; Toyen, Christien; Russo, Paul; Cronin, Angel; Thompson, R. Houston; Schiff, Jeffrey; Bernstein, Melanie; Bains, Manjit.

In: BJU International, Vol. 107, No. 9, 01.05.2011, p. 1386-1393.

Research output: Contribution to journalArticle

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AU - Kaag, Matthew G.

AU - Toyen, Christien

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AU - Schiff, Jeffrey

AU - Bernstein, Melanie

AU - Bains, Manjit

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N2 - Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Renal tumours with caval thrombus are relatively rare. Surgical management is the standard of care for lesions of this nature. Small series have been published by other groups, but our understanding of the optimal management continues to evolve. We present the Memorial Sloan-Kettering Cancer Center series, with a discussion of techniques and complications. Of interest, we include several patients with high-level caval thrombi which were managed without bypass, supporting previous publications by the group from University of Miami. Objective: To report on the contemporary Memorial Sloan-Kettering Cancer Center experience with radical nephrectomy and vena caval thrombectomy. Patients and methods: Patients who underwent radical nephrectomy and vena caval thrombectomy without the use of bypass techniques were retrospectively identified. Data were collected on intraoperative and pathological findings as well as postoperative complications and oncological outcomes. Results: In all, 78 patients underwent radical nephrectomy with off-bypass resection of vena caval thrombus between 1989 and 2009. The median (interquartile range, IQR) operation duration was 293 (226-370) min, and median (IQR) blood loss was 1300 (750-2500) mL. In all, 10 patients (13%) were confirmed to have intra- or supra-hepatic tumour thrombus (level 3/4), eight of whom required supra-hepatic control of the inferior vena cava (IVC). Major (grade 3-5) postoperative complications occurred in 14 (18%), with five postoperative deaths. Disease recurred in 27/62 patients who were considered completely resected at surgery and had adequate follow-up. The overall 5-year survival (95% confidence interval) probability was 48% (35-60%). Conclusions: Radical nephrectomy with vena caval thrombectomy is associated with acceptable postoperative morbidity and mortality, and long-term survival is possible in some patients. Many level 3/4 thrombi could be safely approached without the use of bypass techniques.

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