TY - JOUR
T1 - Bland thrombus association with tumour thrombus in renal cell carcinoma
T2 - Analysis of surgical significance and role of inferior vena caval interruption
AU - Ayyathurai, Rajinikanth
AU - Garcia-Roig, Michael
AU - Gorin, Michael A.
AU - González, Javier
AU - Manoharan, Murugesan
AU - Kava, Bruce R.
AU - Soloway, Mark S.
AU - Ciancio, Gaetano
PY - 2012/12
Y1 - 2012/12
N2 - OBJECTIVE: • To study the role of interruption of the inferior vena cava (IVC) in patients with renal cell carcinoma (RCC) and associated bland and tumour thrombi. METHODS: • We reviewed 129 consecutive patients with the preoperative diagnosis of RCC with tumour thrombus who underwent radical nephrectomy and tumour thrombectomy in one academic institution between May 1997 and February 2011. RESULTS: • Percentages of patients with levels I, II, III and IV tumour thrombus were 29%, 13%, 48% and 9%, respectively. • The perioperative mortality rate was 2.3%. There were 29 (22%) perioperative complications recorded. • In all, 19 patients underwent surgical interruption of the IVC by ligation or segmental resection, including one level II, 14 level III and four level IV thrombi. • A total of 15 patients (12%) had bland thrombus associated with the tumour thrombus; four of these underwent intraoperative IVC filter placement and eight underwent surgical IVC interruption. • Advanced level of tumour thrombus was the only significant factor predicting association of bland thrombus (odds ratio [ OR ] = 2.09, 95% confidence interval [ CI ] : 1.082 - 4.037, P = 0.028). • On multivariate analysis, level of thrombus (OR = 3.1, 95% CI: 1.30 - 7.74, P = 0.011) and association of bland thrombus (OR = 9.07, 95% CI: 2.42 - 34.01, P = 0.001) were significant factors for IVC interruption. CONCLUSIONS: • Surgical interruption of the IVC is a feasible option in selected patients with chronic IVC obstruction. Association of bland thrombus with tumour thrombus should alert the surgical team to the potential for a challenging surgery. • Precise preoperative imaging to assess the degree of venous obstruction and to help with differentiation between bland and tumour thrombus is key to achieving a surgical outcome with minimal morbidity.
AB - OBJECTIVE: • To study the role of interruption of the inferior vena cava (IVC) in patients with renal cell carcinoma (RCC) and associated bland and tumour thrombi. METHODS: • We reviewed 129 consecutive patients with the preoperative diagnosis of RCC with tumour thrombus who underwent radical nephrectomy and tumour thrombectomy in one academic institution between May 1997 and February 2011. RESULTS: • Percentages of patients with levels I, II, III and IV tumour thrombus were 29%, 13%, 48% and 9%, respectively. • The perioperative mortality rate was 2.3%. There were 29 (22%) perioperative complications recorded. • In all, 19 patients underwent surgical interruption of the IVC by ligation or segmental resection, including one level II, 14 level III and four level IV thrombi. • A total of 15 patients (12%) had bland thrombus associated with the tumour thrombus; four of these underwent intraoperative IVC filter placement and eight underwent surgical IVC interruption. • Advanced level of tumour thrombus was the only significant factor predicting association of bland thrombus (odds ratio [ OR ] = 2.09, 95% confidence interval [ CI ] : 1.082 - 4.037, P = 0.028). • On multivariate analysis, level of thrombus (OR = 3.1, 95% CI: 1.30 - 7.74, P = 0.011) and association of bland thrombus (OR = 9.07, 95% CI: 2.42 - 34.01, P = 0.001) were significant factors for IVC interruption. CONCLUSIONS: • Surgical interruption of the IVC is a feasible option in selected patients with chronic IVC obstruction. Association of bland thrombus with tumour thrombus should alert the surgical team to the potential for a challenging surgery. • Precise preoperative imaging to assess the degree of venous obstruction and to help with differentiation between bland and tumour thrombus is key to achieving a surgical outcome with minimal morbidity.
KW - Bland thrombus emboli
KW - Inferior vena cava filter
KW - Pulmonary emboli
KW - Renal tumour
KW - Tumour thrombus
KW - Tumour thrombus emboli
UR - http://www.scopus.com/inward/record.url?scp=84876435543&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84876435543&partnerID=8YFLogxK
U2 - 10.1111/j.1464-410X.2012.11128.x
DO - 10.1111/j.1464-410X.2012.11128.x
M3 - Article
C2 - 22540981
AN - SCOPUS:84876435543
SN - 1464-4096
VL - 110
SP - E449-E455
JO - BJU International
JF - BJU International
IS - 11 B
ER -