Radiologic indicators prior to renal cell cancer thrombectomy: Implications for vascular reconstruction and mortality

Stephen Overholser, Omer Raheem, David Zapata, Dharam Kaushik, Ronald Rodriguez, Ithaar H. Derweesh, Michael A. Liss

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Renal cancer may invade the inferior vena cava (IVC) creating more complex surgical intervention. We investigate radiologic findings that may predict vascular reconstruction prior to surgery and future renal cancer-specific mortality. Materials and Methods: Radiologic findings included Mayo Clinic risk factors for vascular reconstruction: Right-sided tumor, anteroposterior diameter of the IVC at the ostium of the renal vein ≥24.0 mm, and radiologic identification of complete occlusion of the IVC. Additional factors included thrombus in the lumen of the hepatic veins and metastasis. Along with other demographic factors, analysis included Chi-squared analysis for vascular reconstruction and logistic regression for mortality. A Kaplan-Meier curve was created for the most significant radiologic factor. Results: Thirty-seven patients underwent IVC tumor thrombectomy at two institutions from April 2007 to February 2015. We found that Mayo risk factors of 0, 1, 2, and 3 and the proportions of vascular reconstruction of 0%, 0%, 12.5%, and 13.6%, respectively (P = 0.788). Hepatic vein involvement was the most significant determinate of renal cell carcinoma-specific mortality in multivariable analysis, controlling for the size of IVC at the hepatic veins, pulmonary metastasis, and Fuhrman grade (P = 0.02, Log-rank P = 0.002). Conclusion: Mayo risk factors did not predict vascular reconstruction in our small cohort of Level II-Level IV IVC thrombus undergoing IVC thrombectomy. Tumor thrombus traveling into the lumen of the hepatic veins was a significant risk factor for accelerated mortality.

Original languageEnglish (US)
Pages (from-to)312-316
Number of pages5
JournalUrology Annals
Volume8
Issue number3
DOIs
StatePublished - Jul 1 2016
Externally publishedYes

Keywords

  • Inferior vena cava thrombectomy
  • radiographic predictors of mortality
  • renal cell carcinoma

ASJC Scopus subject areas

  • Urology

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