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Perini MV, Ischia J, Woon D, Bhaskar J, Starkey G, Qi S, Wetherell D, Ellard L, McCall P, Miles LF, Seevanayagam S. A novel two-stage approach to the treatment of renal cell carcinoma with intra-cardiac tumour extension and Budd-Chiari syndrome. BJU Int 2024; 133:480-486. [PMID: 38102752 DOI: 10.1111/bju.16257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To present the early results of a new technique for the treatment of renal cell carcinoma with intra-cardiac tumour extension and Budd-Chiari syndrome. PATIENTS AND METHODS The first stage involves transdiaphragmatic debulking of the right heart, inferior vena cava (IVC) and hepatic veins via median sternotomy, followed by a purse-string suture placed in the IVC below the hepatic veins. The second stage is performed separately and involves en bloc resection of the affected kidney, and IVC and vascular reconstruction via an abdominal incision. RESULTS Three of five patients presented with clinical Budd-Chiari syndrome; two had radiological features only. The median time between surgical procedures was 12 days (IQR 13 days). Four of the five patients had a R0 resection. While all five patients successfully completed both operative stages, one patient died 22 days after the second stage. Of the remaining four, all survive with no disease recurrence. CONCLUSION While we continue to compile longer-term data for a larger follow-up series, these preliminary findings show the feasibility of this technique and support the development of this programme of surgery.
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Affiliation(s)
- Marcos V Perini
- Department of Surgery (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Joseph Ischia
- Department of Surgery (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia
- Urology Unit, Austin Health, Melbourne, Victoria, Australia
| | - Dixon Woon
- Urology Unit, Austin Health, Melbourne, Victoria, Australia
| | - Jayapadman Bhaskar
- Brian F. Buxton Cardiac and Thoracic Aortic Surgery Unit, Austin Health, Melbourne, Victoria, Australia
| | - Graham Starkey
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Sara Qi
- Vascular Surgery Unit, Austin Health, Melbourne, Victoria, Australia
| | | | - Louise Ellard
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia
| | - Peter McCall
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia
| | - Lachlan F Miles
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia
| | - Siven Seevanayagam
- Brian F. Buxton Cardiac and Thoracic Aortic Surgery Unit, Austin Health, Melbourne, Victoria, Australia
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Baturu M, Öztürk M, Bayrak Ö, Erturhan S, Seckiner I. Assessing the educational value of laparoscopic radical nephrectomy videos on YouTube®: A comparative analysis of short versus long videos. J Minim Access Surg 2024:01413045-990000000-00048. [PMID: 38557956 DOI: 10.4103/jmas.jmas_355_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/31/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION To evaluate the quality of laparoscopic radical nephrectomy videos and determine the extent to which they are informative and educational for healthcare professionals. PATIENTS AND METHODS We used the YouTube® search engine to search for the term 'laparoscopic radical nephrectomy' with time filters of 4-20 min (Group 1) and >20 min (Group 2) and then sorted the results uploaded chronologically before January 2023. One hundred videos were analysed for each group. The reliability of the videos was assessed using the Journal of American Medical Association (JAMA) Benchmark Criteria and DISCERN questionnaire scores (DISCERN). Educational quality was assessed using the Global Quality Score (GQS) and a 20-item objective scoring system (OSS) for laparoscopic nephrectomy. The popularity of the videos was evaluated using the video power index (VPI). RESULTS The mean video duration was 8.9 ± 4.3 min in Group 1 and 52.02 ± 31.09 min in Group 2 (P < 0.001). The mean JAMA (2.49 ± 0.61) and OSS scores (60 ± 12.3) were higher in Group 2 than in Group 1, while no significant difference was observed in the mean GQS (2.53 ± 0.7, 2.39 ± 0.88, respectively) between the groups (P < 0.001, P = 0.039, P = 0.131, respectively). CONCLUSION While the standardisation of surgical videos published on YouTube® and the establishment of auditing mechanisms do not seem plausible, high total OSS, periprocedural OSS, and VPI scores, and high OSS, JAMAS, GQS and DISCERN scores in long videos indicate that such videos offer a greater contribution to education.
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Affiliation(s)
- Muharrem Baturu
- Department of Urology, Medical Faculty, Gaziantep University, Gaziantep, Turkey
| | - Mehmet Öztürk
- Department of Urology, 25 Aralık State Hospital, Gaziantep, Turkey
| | - Ömer Bayrak
- Department of Urology, Medical Faculty, Gaziantep University, Gaziantep, Turkey
| | - Sakıp Erturhan
- Department of Urology, Medical Faculty, Gaziantep University, Gaziantep, Turkey
| | - Ilker Seckiner
- Department of Urology, Medical Faculty, Gaziantep University, Gaziantep, Turkey
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Faegh A, Moeinafshar A, Rezaei N. Nephrectomy and IVC thrombectomy in renal cancer: a narrative review. Clin Transl Oncol 2024; 26:574-583. [PMID: 37568007 DOI: 10.1007/s12094-023-03302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023]
Abstract
Renal cell carcinoma accounts for two to three percent of adult malignancies and can lead to inferior vena cava (IVC) thrombosis. This condition can decrease the rate of 5-year survival for patients to 60%. The treatment of choice in such cases is radical nephrectomy and inferior vena cava thrombectomy. This surgery is one of the most challenging due to many perioperative complications. There are many controversial methods reported in the literature. Achieving the free of tumor IVC wall and the possibility of thrombectomy in cases of level III and level IV IVC thrombosis are two essential matters previously advocated open approaches. Nevertheless, open approaches are being replaced by minimally invasive techniques despite the difficulty of the surgical management of IVC thrombectomy. This paper aims to review recent evidence about new surgical methods and a comparison of open, laparoscopic, and robotic approaches. In this review, we present the latest surgical strategies for IVC thrombectomy and compare open and minimally invasive approaches to achieve the optimal surgical technique. Due to the different anatomy of the left and right kidneys and variable extension of venous thrombosis, we investigate surgical methods for left and right kidney cancer and each level of IVC venous thrombosis separately.
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Affiliation(s)
- Ali Faegh
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Aysan Moeinafshar
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Children's Medical Center Hospital, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194, Iran.
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Shah MS, Wang KR, Shah YB, Ragam R, Simhal RK, Ghodoussipour S, Djaladat H, Mark JR, Lallas CD, Chandrasekar T. A Narrative Review on Robotic Surgery as Treatment for Renal Cell Carcinoma with Inferior Vena Cava Thrombus. J Clin Med 2024; 13:1308. [PMID: 38592152 PMCID: PMC10932232 DOI: 10.3390/jcm13051308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Renal cell carcinoma (RCC) is a common diagnosis, of which a notable portion of patients present with an extension into the venous circulation causing an inferior vena cava (IVC) tumor thrombus. Venous extension has significant implications for staging and subsequent treatment planning, with recommendations for more aggressive surgical removal, although associated surgical morbidity and mortality is relatively increased. The methods for surgical removal of RCC with IVC thrombus remain complex, particularly surrounding the use of robot-assisted surgery. Robot assistance for radical nephrectomy in this context is recently emerging. Thrombus level has important implications for surgical technique and prognosis. Other preoperative considerations may include location, laterality, size, and wall invasion. The urology literature on treatment of such tumors is largely limited to case series and institutional studies that describe the feasibility of various surgical options for these complex tumors. Further understanding of the outcomes and patient-specific risk factors would shed increased light on the optimal treatment for such cases. This narrative review provides a thorough overview on the previously reported use of robot-assisted nephrectomy in RCC with IVC thrombus to inform further studies which may optimize outcomes and guide shared decision-making.
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Affiliation(s)
- Mihir S. Shah
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Kerith R. Wang
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Yash B. Shah
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Radhika Ragam
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | | | - Saum Ghodoussipour
- Division of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Houman Djaladat
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - James R. Mark
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Costas D. Lallas
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
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Fatehi Hassanabad A, Ball CG, Kidd WT. Inferior vena cava tumor thrombus: clinical outcomes at a canadian tertiary center. Perfusion 2023:2676591231202682. [PMID: 37774418 DOI: 10.1177/02676591231202682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
OBJECTIVE This study reports the surgical management and outcomes of patients with malignancies affecting the IVC. METHODS This was a retrospective study that considered patients undergoing surgery for IVC thrombectomy in Calgary, Canada, from 1 January 2010 to 31 December 2021. Parameters of interest included primary malignancy, the extent of IVC involvement, surgical strategy, and medium-term outcomes. RESULTS Six patients underwent surgical intervention for malignancies that affected the IVC. One patient had a retroperitoneal leiomyosarcoma, 1 had hepatocellular carcinoma with thrombus extending into the IVC and right atrium, 1 had adrenocortical carcinoma with IVC thrombus extending into the right atrium, and 3 had clear cell renal cell carcinoma with thrombus extending into the IVC. Surgical strategy for the IVC thrombectomy varied where 5 patients required the institution of cardiopulmonary bypass and underwent deep hypothermic circulatory arrest. No patient died perioperatively. One patient died 15-months post-operatively from aggressive malignancy. CONCLUSION Different types of malignancy can affect the IVC and surgical intervention is usually indicated for these patients. Herein, we have reported the outcomes of IVC thrombectomy at our center.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Chad G Ball
- Department of Surgery, Foothills Medical Center, Cumming School of Medicine, Calgary, Alberta, Canada
| | - William T Kidd
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, Calgary, Alberta, Canada
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Chen J, Liu Z, Zhang H, Wang G, Tian X, Zhao X, Ge L, Tian Y, Zhang Q, Hong P, Li Y, Chen K, Gao Q, Liu X, Liu C, Ma L, Zhang S. Pure Retroperitoneal Laparoscopic Peritoneum Incision Technique in Right Nephrectomy and Inferior Vena Cava Tumor Thrombectomy: A Novel Surgical Technique and Long-Term Outcomes from a Large Chinese Center. J Endourol 2023; 37:986-994. [PMID: 37254522 DOI: 10.1089/end.2023.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Purpose: To explore the safety and effectiveness of the Pure Retroperitoneal Laparoscopic Peritoneum Incision Technique (PREP-IT) in laparoscopic radical nephrectomy (LRN) and inferior vena cave (IVC) tumor thrombectomy for right renal-cell carcinoma (RCC) with level Mayo I to III venous tumor thrombus (VTT). Patients and Methods: From May 2015 to September 2020, 92 patients with right RCC and Mayo I to III VTT were retrospectively reviewed, including 57 patients who underwent retroperitoneal LRN and IVC thrombectomy using PREP-IT, and 35 patients who underwent open surgery. PREP-IT refers to dissecting the retroperitoneum and temporarily placing the right kidney into the abdominal cavity to enlarge the retroperitoneal workspace for a safer and faster IVC operation. Results: Compared with the open surgery group, the PREP-IT group had a larger tumor diameter, while a larger proportion of Mayo I tumor thrombus and smaller maximum tumor thrombus width. Two patients (3.5%) in the PREP-IT group had a history of abdominal surgery. No conversion to open surgery or standard laparoscopic surgery occurred in PREP-IT group. Laparoscopic surgery with PREP-IT was characterized by shorter operative time, less surgical blood loss, shorter postoperative hospital stay, and lower postoperative complication rate. With a 33-month (ranges: 2-86) follow-up time period, the estimated mean overall survival time was 57.2 ± 5.3 and 58.1 ± 71.5 months in the PREP-IT group and open surgery group, respectively. Log-rank test indicated no significant difference between the two groups in terms of overall survival and cancer-specific survival. Conclusions: The PREP-IT is relatively safe and feasible for retroperitoneal LRN with right renal tumor and IVC tumor thrombus, allowing for a large workspace and wide exposure for IVC operations.
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Affiliation(s)
- Jiyuan Chen
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Xun Zhao
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Liyuan Ge
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Yu Tian
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Qiming Zhang
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Yuxuan Li
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Kewei Chen
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Qiyue Gao
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Xinchen Liu
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
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Elgendi K, Zarli M, Ahmed S, Szell N. Inferior Vena Cava Thrombus Associated With Renal Cell Carcinoma With an Atypical Radiological Presentation: A Case Report. Cureus 2023; 15:e45193. [PMID: 37842479 PMCID: PMC10576161 DOI: 10.7759/cureus.45193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Renal cell carcinoma (RCC) is characterized by the development of kidney masses, which can lead to various long-term complications. Among the extrarenal manifestations associated with RCC, the formation of a thrombus within the inferior vena cava (IVC) is particularly prevalent due to the substantial tumor burden imposed by the kidneys. In this report, we present an exceptional case involving an 80-year-old male patient who presented with an intravascular thrombus within the inferior vena cava (IVC), which originated from RCC. The diagnosis of RCC was conclusively established through core needle biopsy and subsequent tumor marker staining. Remarkably, despite the confirmation of RCC within the IVC thrombus through biopsy and tumor marker analysis, radiological assessments failed to reveal any discernible renal cell masses within the kidneys. The patient subsequently received treatment for RCC with a combination regimen of cabozantinib and nivolumab, which resulted in a noteworthy improvement in his clinical condition. The presentation of RCC in this report is notably atypical, given that the biopsy of the thrombus yielded definitive evidence of RCC while radiological investigations did not yield any indications of renal masses or a tumor burden within the kidneys that would typically be associated with RCC.
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Affiliation(s)
- Kareem Elgendi
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Mohamadhusni Zarli
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Sohaib Ahmed
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Nicole Szell
- Urology, Advanced Urology Institute, Clearwater, USA
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8
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Zhou W, Li X, Wu H. Metastatic melanoma extending along the inferior vena cava to its branches and venous plexus: a rare route metastasis characterized by [ 18F]FDG PET/CT. Eur J Nucl Med Mol Imaging 2023; 50:3149-3150. [PMID: 37093315 DOI: 10.1007/s00259-023-06238-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Wenlan Zhou
- NanFang PET Center, NanFang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong Province, China
- GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
| | - Xiangzhao Li
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
| | - Hubing Wu
- NanFang PET Center, NanFang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong Province, China.
- GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China.
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9
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Scherñuk J, García Marchiñena PA, Carminatti T, Romeo A, Jurado AM. Renal Cell Carcinoma with Venous Extension: Safety of Laparoscopic Surgery for Thrombus Levels I-IIIa. J Endourol 2023; 37:786-792. [PMID: 37212234 DOI: 10.1089/end.2022.0752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
Background: Novel studies are helping to consider minimally invasive surgery for treating patients with renal cell carcinoma and venous tumor thrombus. Evidence regarding its feasibility and safety is still sparse and does not include a subclassification for level III thrombi. We aim to compare the safety of laparoscopic vs open surgery in patients with levels I-IIIa thrombus. Materials and Methods: This is a cross-sectional comparative study using single-institutional data on adult patients treated surgically between June 2008 and June 2022. Participants were categorized into open and laparoscopic surgery groups. Primary outcome was difference in the incidence of 30-day major postoperative complications (Clavien-Dindo III-V) between groups. Secondary outcomes were differences in operative time, length of hospital stay, intraoperative blood transfusions, delta hemoglobin level, 30-day minor complications (Clavien-Dindo I-II), estimated overall survival, and progression-free survival between groups. A logistic regression model was performed including adjustment for confounding variables. Results: Overall, 15 patients in the laparoscopic group and 25 patients in the open group were included. Major complications occurred in 24.0% of patients within the open group and 6.7% of patients were treated laparoscopically (p = 0.120). Minor complications arose in 32.0% of patients treated with open surgery and in 13.3% of patients treated in the laparoscopic group (p = 0.162). Although not significant, there was a higher perioperative death rate within open surgery cases. The laparoscopic approach presented a crude odds ratio for major complications of 0.22 (95% confidence interval 0.02-2.1, p = 0.191) compared with open surgery. No differences were found between groups regarding oncologic outcomes. Conclusion: Laparoscopic approach for patients with venous thrombus levels I-IIIa seems to be as safe as open surgery.
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Affiliation(s)
- Jordán Scherñuk
- Department of Urology, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Tomás Carminatti
- Department of Urology, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Agustín Romeo
- Department of Urology, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alberto M Jurado
- Department of Urology, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Shi X, Pang Q, Nian X, Jiang A, Shi H, Liu W, Gan X, Gao Y, Yang Y, Ji J, Tan X, Xiao C, Zhang W. Integrative transcriptome and proteome analyses of clear cell renal cell carcinoma develop a prognostic classifier associated with thrombus. Sci Rep 2023; 13:9778. [PMID: 37328520 PMCID: PMC10276054 DOI: 10.1038/s41598-023-36978-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) with venous tumor thrombus (VTT) is associated with poor prognosis. Our integrative analyses of transcriptome and proteome reveal distinctive molecular features of ccRCC with VTT, and yield the development of a prognostic classifier to facilitate ccRCC molecular subtyping and treatment. The RNA sequencing and mass spectrometry were performed in normal-tumor-thrombus tissue triples of five ccRCC patients. Statistical analysis, GO and KEGG enrichment analysis, and protein-protein interaction network construction were used to interpret the transcriptomic and proteomic data. A six-gene-based classifier was developed to predict patients' survival using Cox regression, which was validated in an independent cohort. Transcriptomic analysis identified 1131 tumorigenesis-associated differentially expressed genes (DEGs) and 856 invasion-associated DEGs. Overexpression of transcription factor EGR2 in VTT indicated its important role in tumor invasion. Furthermore, proteomic analysis showed 597 tumorigenesis-associated differentially expressed proteins (DEPs) and 452 invasion-associated DEPs. The invasion-associated DEPs showed unique enrichment in DNA replication, lysine degradation, and PPAR signaling pathway. Integration of transcriptome and proteome reveals 142 tumorigenesis-associated proteins and 84 invasion-associated proteins displaying changes consistent with corresponding genes in transcriptomic profiling. Based on their different expression patterns among normal-tumor-thrombus triples, RAB25 and GGT5 were supposed to play a consistent role in both tumorigenesis and invasion processes, while SHMT2 and CADM4 might play the opposite roles in tumorigenesis and thrombus invasion. A prognostic classifier consisting of six DEGs (DEPTOR, DPEP1, NAT8, PLOD2, SLC7A5, SUSD2) performed satisfactorily in predicting survival of ccRCC patients (HR = 4.41, P < 0.001), which was further validated in an independent cohort of 40 cases (HR = 5.52, P = 0.026). Our study revealed the transcriptomic and proteomic profiles of ccRCC patients with VTT, and identified the distinctive molecular features associated with VTT. The six-gene-based prognostic classifier developed by integrative analyses may facilitate ccRCC molecular subtyping and treatment.
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Affiliation(s)
- Xiaolei Shi
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Rd, Shanghai, 200433, China
| | - Qingyang Pang
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Rd, Shanghai, 200433, China
| | - Xinwen Nian
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Rd, Shanghai, 200433, China
| | - Aimin Jiang
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Rd, Shanghai, 200433, China
| | - Haoqing Shi
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Rd, Shanghai, 200433, China
| | - Wenqiang Liu
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Rd, Shanghai, 200433, China
| | - Xinxin Gan
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Rd, Shanghai, 200433, China
| | - Yisha Gao
- Department of Pathology, Changhai Hospital, Naval Medical University, 168 Changhai Rd, Shanghai, 200433, China
| | - Yiren Yang
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Rd, Shanghai, 200433, China
| | - Jin Ji
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Rd, Shanghai, 200433, China
| | - Xiaojie Tan
- Department of Epidemiology, Naval Medical University, 800 Xiangyin Rd, Shanghai, 200433, China
| | - Chengwu Xiao
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Rd, Shanghai, 200433, China.
| | - Wei Zhang
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Rd, Shanghai, 200433, China.
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11
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Baheen Q, Liu Z, Hao Y, Sawh RRR, Li Y, Zhao X, Hong P, Wu Z, Ma L. The Significant Role of Tumor Volume on the Surgical Approach Choice, Surgical Complexity, and Postoperative Complications in Renal Cell Carcinoma With Venous Tumor Thrombus From a Large Chinese Center Experience. Front Oncol 2022; 12:869891. [PMID: 35747828 PMCID: PMC9209712 DOI: 10.3389/fonc.2022.869891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/29/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To explore the role of tumor volume (TV) on surgical approach choice, surgical complexity, and postoperative complications in patients with renal cell carcinoma (RCC) and inferior vena cava tumor thrombus. Method From January 2014 to January 2020, we retrospectively analyzed the clinical data of 132 patients who underwent radical nephrectomy with inferior vena cava thrombectomy (RN-IVCT). Primary renal tumor volume (PRTV), renal vein tumor thrombus volume (RVTTV), inferior vena cava tumor thrombus volume (IVCTTV), and total tumor thrombus volume (TTTV) were measured with the help of an internationally recognized 3D volume measurement software. The patients were divided into three groups according to the tumor volume within the inferior vena cava (IVC). Group 1 included 48 patients with IVCTTV between 0 and 15 cm3 (36.6%), group 2 included 38 patients with IVCTTV between 16 and 30 cm3 (28%), and group 3 included 46 patients with IVCTTV above 30 cm3 (35%). The three IVCTTV groups, as well as four different volume groups, were compared in terms of surgical approach choice, surgical complexity, and postoperative complications. One-way ANOVA and a non-parametric test were used to compare the clinicopathological characteristics and distribution differences between the three groups. Result This study found significant differences among the three groups in the proportion of open surgery (P < 0.001), operation time (P < 0.044), intraoperative bleeding (P < 0.001), and postoperative complications (P < 0.001). When the four different volumes were compared, we found that for higher volumes IVCTTV and TTTV, open surgery is used more often compared with laparoscopic surgery (P < 0.001). In addition, with the increase in renal vein tumor thrombus volume, inferior vena cava tumor thrombus volume, and total tumor thrombus volume, the operation time also increased. Finally, with the increase in tumor thrombus volume and total tumor thrombus volume, the amount of intraoperative bleeding increased. Conclusion With the increase in tumor volume, the proportion of open surgery and the incidence of postoperative complications increased. In addition, larger tumor volume prolongs operation time, increases intraoperative blood loss, and makes the surgery more complicated.
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Hoeh B, Flammia RS, Hohenhorst L, Sorce G, Panunzio A, Chierigo F, Nimer N, Tian Z, Saad F, Gallucci M, Briganti A, Shariat SF, Graefen M, Tilki D, Antonelli A, Terrone C, Kluth LA, Becker A, Chun FK, Karakiewicz PI. Metastatic stage vs complications at radical nephrectomy with inferior vena cava thrombectomy. Surg Oncol 2022; 42:101783. [DOI: 10.1016/j.suronc.2022.101783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/27/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022]
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Multidisciplinary surgical treatment under cardiopulmonary bypass for non-metastatic renal cell carcinoma with Mayo level 4 inferior vena cava thrombus extending into right atrium. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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14
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Keranmu A, Wang M, Li Y, Yang F, Wahafu W, Xing N. Single Position Laparoscopic Radical Nephrectomy and Tumor Thrombectomy for Left Renal Cell Carcinoma With High-Risk Mayo 0 Thrombus. Urology 2021; 160:225-226. [PMID: 34818524 DOI: 10.1016/j.urology.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/31/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Adili Keranmu
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China; State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China; Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Mingshuai Wang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, 100021, Beijing, China
| | - Yajian Li
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Feiya Yang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China; Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Wasilijiang Wahafu
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China; Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Nianzeng Xing
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China; Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China.
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15
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Li SJ, Lee J, Hall J, Sutherland TR. The inferior vena cava: anatomical variants and acquired pathologies. Insights Imaging 2021; 12:123. [PMID: 34460015 PMCID: PMC8405820 DOI: 10.1186/s13244-021-01066-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/07/2021] [Indexed: 01/05/2023] Open
Abstract
The inferior vena cava (IVC) is the largest vein in the body, draining blood from the abdomen, pelvis and lower extremities. This pictorial review summarises normal anatomy and embryological development of the IVC. In addition, we highlight a wide range of anatomical variants, acquired pathologies and a common pitfall in imaging of the IVC. This information is essential for clinical decision making and to reduce misdiagnosis.
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Affiliation(s)
- Simon J Li
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Jean Lee
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jonathan Hall
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Department of Radiology, Austin Health, Heidelberg, VIC, Australia
| | - Tom R Sutherland
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
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