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Barashi NS, Friedman D, Shiang A, Pickersgill N, Vetter J, Suresh T, Ippolito JE, Smith ZL. Growth kinetics of venous tumor thrombus in patients with renal cell carcinoma. Urol Oncol 2024; 42:31.e17-31.e23. [PMID: 38160126 DOI: 10.1016/j.urolonc.2023.12.001] [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: 08/18/2023] [Revised: 11/11/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Some patients with renal cell carcinoma (RCC) present with venous tumor thrombus (VTT). The extent of the VTT is related to survival, so prompt surgical care is recommended. However, studies evaluating the natural history of VTT in patients with RCC are rare. We sought to evaluate the growth kinetics of VTT in patients with RCC using preoperative cross-sectional images. MATERIALS AND METHODS We identified patients who underwent radical nephrectomy and venous tumor thrombectomy at our institution from 01/2009 to 02/2022. We included those with a minimum of 2 adequate preoperative imaging studies (contrast-enhanced Computerized Tomography (CT), noncontrast Magnetic resonance imaging (MRI), or contrast-enhanced MRI), at least 14 days apart. We measured VTT in each study to calculate growth rate, and evaluated predictors of faster growth (demographics, histology, laterality, tumor diameter, and staging). To assess the relation between clinical variables and VTT growth, we used the Wilcoxon Rank-Sum, Kruskal-Wallis, and Spearman correlation tests. RESULTS A total of 30 patients were included in the analysis. The median time interval between studies was 33 days. Patients were mostly Caucasian and Males (90% and 70%, respectively). Most patients underwent a CT scan as their initial imaging study (66%), followed with an MRI as second study (73%). The mean venous tumor thrombus growth rate was 0.3 mm/d (standard deviation of 0.5mm), and only rhabdoid/sarcomatoid differentiation showed an association with tumor thrombus growth rate (0.3 vs. 0.63 mm/d, P = 0.038). CONCLUSIONS To the best of our knowledge, this is the first study evaluating the natural growth rate of venous tumor thrombus in patients with renal cell carcinoma. We found that tumor thrombi grew an average of 0.3 mm/d (1.0 cm/month) and that those with sarcomatoid and/or rhabdoid differentiation grew faster (0.63 mm/d). Further studies are needed to validate these results and provide a better understanding of tumor thrombus kinetics.
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Affiliation(s)
- Nimrod S Barashi
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, MO.
| | - Daniel Friedman
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Alex Shiang
- Washington University in St. Louis School of medicine. St. Louis, MO
| | - Nicholas Pickersgill
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, MO
| | - Joel Vetter
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, MO
| | - Tara Suresh
- Washington University in St. Louis School of medicine. St. Louis, MO
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Zachary L Smith
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, MO
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Jia Z, Tang L, Liu K, Guo A, Huang Q, Peng C, Ding X, Zhang L, Liu G, Yang G, Wang B, Li H, Zhang X, Ma X. Venous tumor thrombus consistency: is it a prognostic factor of survival for patients with renal cell carcinoma? Updates Surg 2023; 75:2033-2038. [PMID: 37395931 DOI: 10.1007/s13304-023-01544-1] [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: 03/26/2023] [Accepted: 05/20/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES To evaluate whether venous tumor thrombus (VTT) consistency is a risk factor for the patient's prognosis with renal cell carcinoma (RCC). MATERIALS AND METHODS A total of 190 RCC patients with VTT, who were treated at Department of Urology, Chinese PLA General Hospital, were retrospectively analyzed in this study. The baseline clinical characteristics, postoperative outcomes, and pathological findings were analyzed. Tumor thrombus was classified as solid and friable based on their respective characteristics. Survival curves were estimated using the Kaplan-Meier survival curve analysis, and univariable and multivariable cox proportional hazard regression models were used. RESULTS Among the total 190 patients included in this study, 145 (76.3%) patients had solid VTT, and 45 (23.7%) patients had friable VTT in their renal veins and inferior vena cava (IVC). There were no significant differences in the age, gender, BMI, symptoms, complex diseases, tumor side, tumor size, TNM stage, Mayo stage, tumor grade, sarcomatous differentiation, pelvic invasion, and sinus fat invasion of patients. Solid VTT consistency was more likely to have a capsule as compared to those with friable VTT (P = 0.007). Kaplan-Meier survival curve analysis demonstrated no statistically significant differences in the overall survival (OS) (P = 0.973) and progression-free survival (PFS) (P = 0.667) of patients. Moreover, VTT consistency was not associated with OS (P = 0.706) of PFS (P = 0.504) in multivariate cox regression analysis. CONCLUSIONS RCC VTT consistency was not a prognostic risk factor for predicting the OS and PFS of patients.
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Affiliation(s)
- Zhuo Jia
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Lu Tang
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Kan Liu
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Aitao Guo
- Department of Pathology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Qingbo Huang
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Cheng Peng
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Xiaohui Ding
- Department of Pathology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Lifeng Zhang
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Guojun Liu
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Guoqiang Yang
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Baojun Wang
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Hongzhao Li
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China
| | - Xu Zhang
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China.
| | - Xin Ma
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853, China.
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Tobe T, Terakawa T, Hara T, Ueki H, Shiraishi Y, Wakita N, Okamura Y, Bando Y, Furukawa J, Nakano Y, Harada K, Fujisawa M. The Efficacy of Presurgical Therapy With Avelumab and Axitinib for Renal Cell Carcinoma With Inferior Vena Cava Tumor Thrombus. Clin Genitourin Cancer 2023; 21:613.e1-613.e6. [PMID: 37236863 DOI: 10.1016/j.clgc.2023.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Taisuke Tobe
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tomoaki Terakawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Takuto Hara
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hideto Ueki
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yusuke Shiraishi
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Naoto Wakita
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yasuyoshi Okamura
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yukari Bando
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Junya Furukawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yuzo Nakano
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kenichi Harada
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Li KP, Chen SY, Wang CY, Li XR, Yang L. Perioperative and oncologic outcomes of minimally-invasive surgery for renal cell carcinoma with venous tumor thrombus: a systematic review and meta-analysis of comparative trials. Int J Surg 2023; 109:2762-2773. [PMID: 37526108 PMCID: PMC10498880 DOI: 10.1097/js9.0000000000000405] [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: 01/09/2023] [Accepted: 04/06/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The present study aimed to conduct a pooled analysis to compare the perioperative and oncologic outcomes of minimally-invasive radical nephrectomy with tumor thrombus (MI-RNTT) with open radical nephrectomy with tumor thrombus (O-RNTT). METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Four electronic databases (PubMed, Embase, Web of Science, and the Cochrane Library database) were systematically searched to identify relevant studies published in English up to December 2022. The primary outcomes were perioperative results, complications, and oncologic outcomes. Review Manager 5.4 was used for this analysis. RESULTS In total, eight retrospective trials with a total of 563 patients were included. Compared to O-RNTT, MI-RNTT had shorter hospitalization time [weighted mean difference (WMD) -3.58 days, 95% CI: -4.56 to -2.59; P <0.00001), lower volumes of blood loss (WMD -663.32 ml, 95% CI: -822.22 to -504.42; P <0.00001), fewer transfusion rates (OR 0.18, 95% CI: 0.09-0.35; P <0.00001), fewer overall complications (OR 0.33, 95% CI: 0.22-0.49; P <0.00001), and fewer major complications s (OR 0.49, 95% CI: 0.24-1.00; P =0.05). However, operative time, intraoperative complications, mortality rate (intraoperative, within 30 days, and total mortality), overall survival, recurrence-free survival, and cancer-specific survival did not significantly differ between the two groups. CONCLUSIONS MI-RNTT possesses more benefits than O-RNTT in terms of length of hospital stay, blood loss, and complications and provides comparable mortality rates and oncologic outcomes. However, more comprehensive and rigorous research is warranted to further validate the outcomes, which should include a larger sample size and comprehensive data from high-volume medical centers.
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Affiliation(s)
| | | | | | - Xiao-ran Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, People’s Republic of China
| | - Li Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, People’s Republic of China
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Schmeusser BN, Midenberg E, Palacios AR, Ali AA, Patil DH, Higgins M, Nabavizadeh R, Croll B, Williams M, Sheehy J, Zheng B, Narayan VM, Joshi SS, Ogan K, Psutka SP, Bilen MA, Master VA. Low Skeletal Muscle as a Risk Factor for Worse Survival in Nonmetastatic Renal Cell Carcinoma with Venous Tumor Thrombus. Clin Genitourin Cancer 2023:S1558-7673(23)00092-7. [PMID: 37210313 DOI: 10.1016/j.clgc.2023.04.005] [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: 01/31/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Renal cell carcinoma (RCC) with tumor thrombosis often requires nephrectomy and tumor thrombectomy. As an extensive and potentially morbid operation, patient preoperative functional reserve and body composition is an important consideration. Sarcopenia is a risk factor for increased postoperative complications, systemic therapy toxicity, and death solid organ tumors, including RCC. The influence of sarcopenia in RCC patients with tumor thrombus is not well defined. This study evaluates the prognostic ability of sarcopenia regarding surgical outcomes and complications in patients undergoing surgery for RCC with tumor thrombus. METHODS We retrospectively analyzed patients with nonmetastatic RCC and tumor thrombus undergoing radical nephrectomy and tumor thrombectomy. Skeletal muscle index (SMI; cm2/m2) was measured on preoperative CT/MRI. Sarcopenia was defined using body mass index- and sex-stratified thresholds optimally fit via a receiver-operating characteristic analysis for survival. Associations between preoperative sarcopenia and overall (OS), cancer-specific survival (CSS), and 90-day major complications were determined using multivariable analysis. RESULTS 115 patients were analyzed, with median (IQR) age and body mass index of 69 (56-72) and 28.6 kg/m2 (23.6-32.9), respectively. 96 (83.4%) of the cohort had ccRCC. Sarcopenia was associated with shorter median OS (P = .0017) and CSS (P = .0019) in Kaplan-Meier analysis. In multivariable analysis, preoperative sarcopenia was prognostic of shorter OS (HR = 3.38, 95% confidence interval [CI] 1.61-7.09) and CSS (HR = 5.15, 95% CI 1.46-18.18). Notably, 1 unit increases in SMI were associated with improved OS (HR = 0.97, 95% CI 0.94-0.999) but not CSS (HR = 0.95, 95% CI 0.90-1.01). No significant relationship between preoperative sarcopenia and 90-day major surgical complications was observed in this cohort (HR = 2.04, 95% CI 0.65-6.42). CONCLUSION Preoperative sarcopenia was associated with decreased OS and CSS in patients surgically managed for nonmetastatic RCC and VTT, however, was not predictive of 90-day major postoperative complications. Body composition analysis has prognostic utility for patients with nonmetastatic RCC and venous tumor thrombus undergoing surgery.
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Affiliation(s)
| | - Eric Midenberg
- Department of Urology, University of Louisville School of Medicine, Louisville, KY
| | - Arnold R Palacios
- Department of Urology, Creighton University School of Medicine, Omaha, NE
| | - Adil A Ali
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | - Michelle Higgins
- Department of Urology, Emory University School of Medicine, Atlanta, GA; The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Benjamin Croll
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Milton Williams
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - John Sheehy
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Bill Zheng
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Vikram M Narayan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Shreyas S Joshi
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA.
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Poirier T, Karam G, Bouchot O, De Vergie S, Branchereau J, Perrouin-Verbe MA, Rigaud J. [Results of the management of kidney cancer with extension into the inferior vena cava: A retrospective, single-center, observational study]. Prog Urol 2023; 33:333-343. [PMID: 37076361 DOI: 10.1016/j.purol.2023.03.004] [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: 11/28/2022] [Revised: 02/26/2023] [Accepted: 03/27/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVES The aim of our study was to evaluate the morbidity and mortality, as well as the oncogical results of patients who had undergone surgical procedure for a kidney cancer with thrombus extension into the inferior vena cava. MATERIALS AND METHODS Between January 2004 and April 2020, 57 patients were operated by enlarged nephrectomy with thrombectomy for kidney cancer with thrombus extension in the inferior vena cava. Twelve patients (21%) with the use of cardiopulmonary bypass because the thrombus was upper than the sus-hepatic veins. Twenty-three patients (40.4%) were metastatic at diagnosis. RESULTS Perioperative mortality was 10.5%, without difference according to surgical technique. Morbidity during hospitalization was 58%, without difference according to surgical technique. Median follow-up was 40.8±40.1months. Overall survival at 2 and 5years was 60% and 28%, respectively. At 5years, the principal prognostic factor was the metastatic status at diagnosis, in multivariate analysis (OR: 0.15, P=0.03). Progression free survival mean was 28.2±40.2months. Progression free survival at 2 and 5years was 28% and 18%, respectively. All the patients who were metastatic at diagnosis had a recurrence in an average time of 5.7months (median of 3months). Thirteen percent of patients can be considered cured at the end of the study. CONCLUSION Morbidity and mortality of this surgery remain important. The metastatic status at diagnosis has appeared to be the principal prognostic factor on the survival of these patients. LEVEL OF EVIDENCE Level 4: retrospective study.
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Affiliation(s)
- Thomas Poirier
- Service d'urologie et de transplantations rénales, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - Georges Karam
- Service d'urologie et de transplantations rénales, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - Olivier Bouchot
- Service d'urologie et de transplantations rénales, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - Stéphane De Vergie
- Service d'urologie et de transplantations rénales, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - Julien Branchereau
- Service d'urologie et de transplantations rénales, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - Marie-Aimée Perrouin-Verbe
- Service d'urologie et de transplantations rénales, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - Jérôme Rigaud
- Service d'urologie et de transplantations rénales, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
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Kotlyar MJ, Krebs M, Solimando AG, Marquardt A, Burger M, Kübler H, Bargou R, Kneitz S, Otto W, Breyer J, Vergho DC, Kneitz B, Kalogirou C. Critical Evaluation of a microRNA-Based Risk Classifier Predicting Cancer-Specific Survival in Renal Cell Carcinoma with Tumor Thrombus of the Inferior Vena Cava. Cancers (Basel) 2023; 15:cancers15071981. [PMID: 37046643 PMCID: PMC10093292 DOI: 10.3390/cancers15071981] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
(1) Background: Clear cell renal cell carcinoma extending into the inferior vena cava (ccRCCIVC) represents a clinical high-risk setting. However, there is substantial heterogeneity within this patient subgroup regarding survival outcomes. Previously, members of our group developed a microRNA(miR)-based risk classifier—containing miR-21-5p, miR-126-3p and miR-221-3p expression—which significantly predicted the cancer-specific survival (CSS) of ccRCCIVC patients. (2) Methods: Examining a single-center cohort of tumor tissue from n = 56 patients with ccRCCIVC, we measured the expression levels of miR-21, miR-126, and miR-221 using qRT-PCR. The prognostic impact of clinicopathological parameters and miR expression were investigated via single-variable and multivariable Cox regression. Referring to the previously established risk classifier, we performed Kaplan–Meier analyses for single miR expression levels and the combined risk classifier. Cut-off values and weights within the risk classifier were taken from the previous study. (3) Results: miR-21 and miR-126 expression were significantly associated with lymphonodal status at the time of surgery, the development of metastasis during follow-up, and cancer-related death. In Kaplan–Meier analyses, miR-21 and miR-126 significantly impacted CSS in our cohort. Moreover, applying the miR-based risk classifier significantly stratified ccRCCIVC according to CSS. (4) Conclusions: In our retrospective analysis, we successfully validated the miR-based risk classifier within an independent ccRCCIVC cohort.
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Affiliation(s)
- Mischa J. Kotlyar
- Department of Urology and Pediatric Urology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Markus Krebs
- Department of Urology and Pediatric Urology, University Hospital Würzburg, 97080 Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Antonio Giovanni Solimando
- Guido Baccelli Unit of Internal Medicine, Department of Precision and Regenerative Medicine and Ionian Area-(DiMePRe-J), School of Medicine, Aldo Moro University of Bari, 70124 Bari, Italy
- IRCCS Istituto Tumori “Giovanni Paolo II” of Bari, 70124 Bari, Italy
| | - André Marquardt
- Department of Pathology, Klinikum Stuttgart, 70174 Stuttgart, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef, University of Regensburg Medical Center, 93053 Regensburg, Germany
| | - Hubert Kübler
- Department of Urology and Pediatric Urology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Ralf Bargou
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Susanne Kneitz
- Physiological Chemistry I, Theodor-Boveri-Institute, Biocenter, University of Würzburg, 97074 Würzburg, Germany
| | - Wolfgang Otto
- Department of Urology, Caritas St. Josef, University of Regensburg Medical Center, 93053 Regensburg, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef, University of Regensburg Medical Center, 93053 Regensburg, Germany
| | - Daniel C. Vergho
- Department of Urology, Caritas St. Josef, University of Regensburg Medical Center, 93053 Regensburg, Germany
| | - Burkhard Kneitz
- Department of Urology and Pediatric Urology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Charis Kalogirou
- Department of Urology and Pediatric Urology, University Hospital Würzburg, 97080 Würzburg, Germany
- Correspondence: ; Tel.: +49-931-201-32001
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Zhang Y, Bi H, Yan Y, Liu Z, Wang G, Song Y, Zhang S, Liu C, Ma L. Comparative analysis of surgical and oncologic outcomes of robotic, laparoscopic and open radical nephrectomy with venous thrombectomy: a propensity-matched cohort study. Int J Clin Oncol 2023; 28:145-154. [PMID: 36380158 DOI: 10.1007/s10147-022-02265-y] [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: 05/10/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide insight into the surgical and oncological outcomes of robotic, laparoscopic and open radical nephrectomy with venous thrombectomy (RALRN-VT, LRN-VT, ORN-VT) in patients with renal tumor and venous thrombus. MATERIALS AND METHODS A propensity-matched retrospective cohort study containing 324 patients with renal tumor and venous thrombus from January 2014 to August 2021 was analyzed. We compared surgical outcomes and we used the Kalan-Meier method to assess the overall survival (OS), tumor-specific survival (TSS), metastasis-free survival (MFS) and local recurrence-free survival (LRFS). The Pearson chi-square test and Fisher exact test, Wilcoxon rank sum test, Cox proportional hazards regression model and log-rank test were used. RESULTS After matching, baseline characteristics were comparable in the RALRN-VT, LRN-VT and ORN-VT group. The RALRN-VT group had the least operative time (median 134 min vs 289 min vs 330 min, P < 0.001), the least blood loss (median 250 ml vs 500 ml vs 1000 ml, P < 0.001) and the fewest packed red blood cells transfusion (median 400 ml vs 800 ml vs 1200 ml, P < 0.001). The ORN-VT group had the highest complication rate (18.2 vs 22.7 vs 43.2%, P = 0.005), the highest Clavien grade (P = 0.001) and the longest postoperative hospital stay (median 7d vs 8d vs 10d, P < 0.001). No significant difference in OS, TSS and MFS between the minimally invasive procedures (MIP, including RALRN-VT and LRN-VT) group and ORN-VT group was found. The hazard ratio of LRFS for the MIP group was 0.20 (95% CI 0.06-0.70, P = 0.01) compared with ORN-VT group. CONCLUSIONS RALRN-VT can result in the best surgical outcomes compared with LRN-VT and ORN-VT. The MIP group had a better LRFS compared with ORN-VT group.
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Affiliation(s)
- Yu Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - Hai Bi
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - Ye Yan
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - GuoLiang Wang
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - YiMeng Song
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - ShuDong Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China.
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China.
| | - LuLin Ma
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China.
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Horynecka Z, Jabłońska B, Kurek A, Lekstan A, Piaszczyński M, Mrowiec S, Oczkowicz G, Król R. Analysis of surgical outcomes in 102 patients with renal cell carcinoma with venous tumor thrombus: A retrospective observational single-center study. Medicine (Baltimore) 2022; 101:e30808. [PMID: 36221402 PMCID: PMC9542917 DOI: 10.1097/md.0000000000030808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The aim of the study was to assess short- and long-term results following radical nephrectomy with renal vein and inferior vena cava thrombectomy in patients with renal cell cancer with venous thrombus and to investigate impact of various demographical, clinical and histological factors on overall survival (OS). The medical records of 102 adult patients with renal cell cancer with venous thrombus admitted for surgery in Department of General, Vascular and Transplant Surgery from 2012 to 2019 were retrospectively analyzed. The tumor was more frequently located on the right side compared to the left one (55 vs. 47). According to Neves Zincke classification, the levels of venous thrombus were as follows: 1 to 48 (47%), 2 to 47 (46%), 3 to 6 (6%), and 4 to 1 (1%). Postoperative complications were noted in 16 (15.7%) patients. One (3%) patient (Neves Zincke 2) died of intraoperative pulmonary embolism during hospitalization. Clear cell carcinoma was the most common pathological type reported in 92 (90.2%) patients. Thirty nine (38.2%) patients were alive at the time of last follow-up. The median OS was 21.50 (0-101.17) months. The 1-year OS was 75.5%. Significantly better OS (median 38.03 months) was noted in patients with RCC Neves Zincke 1 compared to OS (median 14.79 months) in patients with Neves Zincke 2-4 VT (P = .008). Higher tumor staging (T3 vs. T4) (P = .038), nodal staging (N0 vs. N1) (P = .0008), Fuhrman histological grading (G1-2 vs. G3-4) (P = .033) were associated with a shorter OS. Patients with renal cell cancer with venous thrombus, with an acceptable perioperative risk, should be treated surgically, because radical nephrectomy with thrombectomy performed in a high volume surgical center is a safe procedure. Neves Zincke 2-4 venous thrombus, higher tumor and nodal staging, as well higher Fuhrman histological grading are associated with a shorter OS.
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Affiliation(s)
- Zuzanna Horynecka
- Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland
| | - Beata Jabłońska
- Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
- *Correspondence: Beata Jabłońska, Department of Digestive Tract Surgery, Medical University of Silesia, 40-752 Katowice, Poland ()
| | - Adam Kurek
- Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland
| | - Andrzej Lekstan
- Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland
| | - Michał Piaszczyński
- Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland
| | - Sławomir Mrowiec
- Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Oczkowicz
- Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland
| | - Robert Król
- Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland
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Wang T, Huang Y, Yang L, Yang Y, Li D, Zhang X, Ding X, Wang B, Ma X. Histological features suggestive of survival in patients with renal cell carcinoma and tumor thrombus: A single-center experience. Front Oncol 2022; 12:980564. [PMID: 36132138 PMCID: PMC9483090 DOI: 10.3389/fonc.2022.980564] [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: 06/28/2022] [Accepted: 08/17/2022] [Indexed: 11/14/2022] Open
Abstract
Purpose To evaluate the impact of histological subtype on the survival of patients with renal cell carcinoma (RCC) and tumor thrombus (TT). Patients and methods We retrospectively analyzed 350 patients with RCC and TT admitted to Chinese People’s Liberation Army General Hospital between January 2006 and June 2021. The patients underwent radical nephrectomy and thrombectomy using robot-assisted laparoscopic, laparoscopic, or open surgery. The clinical and pathological parameters of the patients were taken from their medical records. Survival was calculated with the Kaplan–Meier method. Univariate and multivariate Cox regression analyses were performed to evaluate the prognostic significance of variables on overall survival (OS) and progression-free survival (PFS). Results TT levels 0–IV were observed in 132 (37.71%), 43 (12.29%), 134 (38.29%), 20 (5.71) and 21 (6.00%) patients, respectively. Papillary (pRCC), clear cell, and other histological subtypes of RCC were detected in 28 (8.00%), 286 (81.71%), and 36 (10.29%) patients, respectively. Compared to the clear cell cohort, collecting systemic invasion (46.43 vs. 25.17%; p = 0.030) and lymph node metastasis (39.29 vs. 11.54%; p < 0.01) were more common in the pRCC cohort. Kaplan–Meier analyses showed that patients with pRCC and other subtypes had significantly worse OS and PFS compared to patients with the clear cell subtype (p < 0.05). Multivariate analyses revealed that histology was independently associated with reduced OS and PFS, including among patients without lymph node and distant metastasis (N0M0). Conclusion Papillary or other subtypes have a considerably shorter OS and PFS compared to clear cell subtype in RCC patients with TT. Strict follow-up and surveillance should be performed for papillary or other subtypes RCC with TT.
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Affiliation(s)
- Tao Wang
- Medical School of Chinese PLA, Beijing, China
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yan Huang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Luojia Yang
- Medical School of Chinese PLA, Beijing, China
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yang Yang
- Medical School of Chinese PLA, Beijing, China
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Di Li
- Medical School of Chinese PLA, Beijing, China
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xiangyi Zhang
- Medical School of Chinese PLA, Beijing, China
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xiaohui Ding
- Department of Pathology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Xiaohui Ding, ; Baojun Wang, ; Xin Ma,
| | - Baojun Wang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Xiaohui Ding, ; Baojun Wang, ; Xin Ma,
| | - Xin Ma
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Xiaohui Ding, ; Baojun Wang, ; Xin Ma,
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Sanyal SR, Arora A, Nisreen A, Mohamed K, Mohammad SK, Baruah D. Imaging Tips and Tricks in Management of Renal and Urothelial Malignancies. Indian J Radiol Imaging 2022; 32:213-223. [PMID: 35924135 PMCID: PMC9340167 DOI: 10.1055/s-0042-1744520] [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] [Indexed: 10/25/2022] Open
Abstract
AbstractManagement of urological malignancies has evolved significantly with continually changing guidelines and treatment options which demand more centralized involvement of radiology than ever before.Radiologists play a pivotal role in interpreting complex cancer scans and guiding clinical teams toward the best management options in the light of clinical profile. Management of complex uro-oncology cases is often discussed in multidisciplinary meetings which are essential checkpoints to evaluate an overall picture and formulate optimal treatment plans.The aim of this article is to provide a radiological perspective with practical guidance to fellow radiologists participating in uro-oncology multidisciplinary meetings based on commonly encountered case scenarios, updated guidelines, and cancer pathways.Crucial imaging tips with regards to renal and urinary tract cancers, upon which therapeutic decisions are made, have been condensed in this article after reviewing several complex cases from urology multidisciplinary meetings and European Association of Urology guidelines.Outline of various diagnostic and management strategies, key staging features, surveillance guidelines, and, above all, what the onco-urologists want to know from radiologists have been succinctly discussed in this article.
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Affiliation(s)
| | - Ankur Arora
- Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trusst, Liverpool, United Kingdom
| | - Amin Nisreen
- Department of Radiology, Royal Preston Hospital, Preston, United Kingdom
| | - Khattab Mohamed
- Department of Radiology, Royal Preston Hospital, Preston, United Kingdom
| | | | - Deb Baruah
- Department of Radiology, Tezpur Medical College, Assam, India
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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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Oncologic Outcomes of Renal Cell Carcinoma Patients Undergoing Radical Nephrectomy and Venous Thrombectomy: Prospective Follow-Up from a Single Center. JOURNAL OF ONCOLOGY 2022; 2022:9191659. [PMID: 35342403 PMCID: PMC8947865 DOI: 10.1155/2022/9191659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/18/2022] [Indexed: 12/31/2022]
Abstract
Purpose To evaluate the long-term oncologic outcomes of renal cell carcinoma (RCC) patients with venous thrombus after radical nephrectomy and venous thrombectomy (RN-VT) and to determine the prognostic factors. Methods and Materials We reported our follow-up data of RCC patients with venous thrombus from January 2014 to September 2020. We used the Kaplan-Meier method to assess the overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). The Cox proportional hazards regression model and competing risk model were used. Results After a median follow-up of 31 mon, eight-five patients (31.5%) died, and cancer-specific deaths occurred in 60 patients (22.2%). The 1 yr and 3 yr CSS were 89.3% and 72.7%, respectively. The median OS was 56.0 mon (95% CI 47.6-64.3 mon), and the 1 yr, 3 yr, and 5 yr OS were 87.0%, 62.1%, and 44.8%, respectively. For M1 patients, the median OS was 27.0 mon (95% CI 22.0-42.0 mon), and the 1 yr, 3 yr, and 5 yr OS were 78.0%, 41.5%, and 23.3%, respectively. For M0 patients, the median RFS was 38.0 mon (95% CI 32.5-43.5 mon), and the 1 yr and 3 yr RFS were 81.2% and 52.3%, respectively. Multivariate analyses showed that papillary RCC (HR 2.95, 95% CI 1.80-4.82, P < 0.001) or other RCC (HR 3.88, 95% CI 2.03-7.41, P < 0.001), perinephric fat invasion (HR 1.53, 95% CI 1.03-2.26, P = 0.04), sarcomatoid differentiation (HR 2.85, 95% CI 1.64-4.95, P < 0.001), Fuhrman grade 3 (HR 2.10, 95% CI 1.28-3.44, P = 0.003) or 4 (HR 3.55, 95% CI 2.09-6.03, P < 0.001), and distant metastasis (HR 1.76, 95% CI 1.18-2.63, P = 0.006) were associated with a worse CSS. Adjuvant therapy (HR 0.63, 95% CI 0.43-0.92, P = 0.02) was associated with a better CSS. Conclusions RCC patients can have an acceptable long-term survival after RN-VT. Prognostic factors influencing CSS included nonclear cell RCC histology, higher Fuhrman grade, sarcomatoid differentiation, perinephric fat invasion, distant metastasis, and adjuvant therapy.
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Zhang Y, Tian X, Bi H, Yan Y, Liu Z, Liu C, Zhang S, Ma L. A Nomogram Predicting the Progression-Free Survival of Nonmetastatic Renal Cell Carcinoma Patients With Venous Thrombus After Surgery. Front Oncol 2022; 12:765092. [PMID: 35402218 PMCID: PMC8988056 DOI: 10.3389/fonc.2022.765092] [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: 08/26/2021] [Accepted: 02/24/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives To demonstrate the progression-free survival (PFS) of nonmetastatic renal cell carcinoma (RCC) patients with venous thrombus after radical nephrectomy and venous thrombectomy (RN-VT) and to develop and validate a nomogram to predict the PFS of patients after RN-VT. Materials and Methods We reported our prospective follow-up data of RCC patients with venous thrombus from January 2014 to September 2020 (n = 199). We used the Kaplan–Meier method to assess the PFS. The Cox proportional hazards regression model was used to determine the predictors. Nomograms predicting the PFS was established, and external validation was performed. Calibration curves and decision curves were generated to assess the predictive efficacy and clinical benefit. Results After a median follow-up of 32 months, 79 patients (39.7%) had disease progression and the median PFS was 41.0 months (95% CI 34.8–53.2 months). The 1-year, 3-year, and 5-year PFS rates were 78.4%, 45.4%, and 30.0%, respectively. Multivariate analysis showed that Fuhrman grade [grade 4: hazard ratio (HR) 1.92, 95% CI 1.10–3.34, P = 0.02], pathological type (papillary RCC: HR 3.02, 95% CI 1.79–5.10, P < 0.001), perinephric fat invasion (HR 1.54, 95% CI 1.12–2.10, P = 0.007), sarcomatoid differentiation (HR 2.97, 95% CI 1.24–7.13, P = 0.02) were associated with a worse PFS, and adjuvant therapy (HR 0.32, 95% CI 0.18–0.59, P < 0.001) could lead to a better PFS. A nomogram based on the predictors was externally validated to have good discrimination and calibration, and it could improve PFS prediction to obtain a clinical benefit. Conclusions We constructed and validated a nomogram to predict the 1-year, 3-year, and 5-year PFS of M0 RCC patients with venous thrombus after surgery. The model can help identify patients who can benefit the most from surgery and develop the criteria for clinical trial enrollment.
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Affiliation(s)
| | | | | | | | | | | | | | - LuLin Ma
- *Correspondence: LuLin Ma, ; ShuDong Zhang,
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15
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Surgical treatment of renal cell carcinoma with inferior vena cava tumor thrombus. Surg Today 2022; 52:1125-1133. [PMID: 34977987 DOI: 10.1007/s00595-021-02429-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The present report discusses the indications of cardiopulmonary bypass (CPB) in open nephrectomy and surgical outcomes of conventional and minimally invasive surgical techniques for treating advanced renal cell carcinoma with inferior vena cava tumor thrombus. METHODS The present study involved a comprehensive retrieval of pertinent literature from the most recent two decades. RESULTS Comparisons between radical nephrectomy procedures in terms of open, laparoscopic and robotic-assisted surgeries revealed that open surgery had more blood loss, a longer operation time and higher mortality rates than laparoscopic and robotic-assisted surgeries. Furthermore, surgery with CPB was associated with more blood loss than non-CPB surgery. Rates of early and late deaths were much higher in patients with CPB than in those without CPB. CONCLUSIONS Different surgical techniques had different indications in terms of levels of inferior vena cava tumor thrombus. The laparoscopic, robotic-assisted, open surgical techniques and CPB with deep hypothermic circulatory arrest were indicated for Levels I, II, III and III-IV inferior vena cava tumor thrombus, respectively. Laparoscopic and robotic-assisted surgeries cause less trauma than open surgery but require more complicated equipments to support the procedure. CPB should be avoided in radical nephrectomy whenever possible. The increased application of laparoscopic and robotic techniques in the future is anticipated.
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Suzuki I, Kijima T, Takada‐Owada A, Nakamura G, Uematsu T, Sakamoto K, Nishihara D, Ishida K, Kamai T. A case of clear cell renal cell carcinoma with vena cava thrombus responding to presurgical avelumab, and axitinib. IJU Case Rep 2021; 4:412-416. [PMID: 34755071 PMCID: PMC8560442 DOI: 10.1002/iju5.12362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION We report a case of renal cell carcinoma with vena cava thrombus showing a marked reduction with presurgical avelumab plus axitinib, facilitating nephrectomy with thrombectomy. CASE PRESENTATION A 50-year-old man was taken to emergent care unit due to spontaneous renal rupture and was diagnosed to have left-sided renal cell carcinoma with level IV tumor thrombus. After hemostasis was obtained via transcatheter arterial embolization, avelumab plus axitinib was introduced because upfront surgery was deemed unfeasible due to poor performance status and possible retroperitoneal tumor dissemination. After four treatment cycles, thrombus was reduced to level II, and nephrectomy with thrombectomy was performed. Histological analyses revealed massive CD8+ T cell infiltration in the thrombus, suggesting immunotherapy efficacy. He has remained recurrence-free without any additional treatment for eight months. CONCLUSION For locally advanced renal cell carcinoma with vena cava thrombus, presurgical combination therapy with avelumab plus axitinib could be an option to facilitate curative surgery.
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Affiliation(s)
- Issei Suzuki
- Departments ofUrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Toshiki Kijima
- Departments ofUrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Atsuko Takada‐Owada
- Department ofDiagnostic PathologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Gaku Nakamura
- Departments ofUrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Toshitaka Uematsu
- Departments ofUrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Kazumasa Sakamoto
- Departments ofUrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Daisaku Nishihara
- Departments ofUrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Kazuyuki Ishida
- Department ofDiagnostic PathologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Takao Kamai
- Departments ofUrologyDokkyo Medical UniversityShimotsugaTochigiJapan
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Prevalence and risk factors of myocardial and acute kidney injury following radical nephrectomy with vena cava thrombectomy: a retrospective cohort study. BMC Anesthesiol 2021; 21:243. [PMID: 34641781 PMCID: PMC8513361 DOI: 10.1186/s12871-021-01462-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radical nephrectomy with thrombectomy is the mainstay treatment for patients with renal cell carcinoma with vena cava thrombus. But the procedure is full of challenge, with high incidence of major complications and mortality. Herein, we investigated the incidence and predictors of myocardial injury and acute kidney injury (AKI) in patients following radical nephrectomy with inferior vena cava thrombectomy. METHODS Patients who underwent nephrectomy with thrombectomy between January 2012 and June 2020 were retrospectively reviewed. Myocardial injury was diagnosed when peak cardiac troponin I was higher than 0.03 ng/ml. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Multivariable logistic regression models were used to identify predictors of myocardial injury or AKI after surgery. RESULTS A total of 143 patients were included in the final analysis. Myocardial injury and AKI occurred in 37.8 and 42.7% of patients after this surgery, respectively. Male sex (odds ratio [OR] 0.27, 95% confidence interval [CI] 0.10-0.71; P = 0.008) was associated with a lower risk, whereas high level Mayo classification (compared with Mayo level I + II, Mayo level III + IV: OR 4.21, 95% CI 1.42-12.4; P = 0.009), acute normovolemic hemodilution before surgery (OR 2.66, 95% CI 1.10-6.41; P = 0.029), long duration of intraoperative tachycardia (per 20 min: OR 1.49, 95% CI 1.10-2.16; P = 0.036), and long duration of surgery (per 1 h, OR 1.48, 95% CI 1.03-2.16, P = 0.009) were associated with a higher risk of myocardial injury. High body mass index (OR 1.18, 95% CI 1.06-1.33; P = 0.004) and long duration of intraoperative hypotension (per 20 min: OR 1.30, 95% CI 1.04-1.64; P = 0.024) were associated with a higher risk, whereas selective renal artery embolism before surgery (OR 0.20, 95% CI 0.07-0.59, P = 0.004) was associated with a lower risk of AKI. CONCLUSION Myocardial injury and AKI were common in patients recovering from radical nephrectomy with inferior vena cava thrombectomy. Whether interventions targeting the above modifiable factors can improve outcomes require further studies.
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Shiff B, Breau RH, Mallick R, Pouliot F, So A, Tanguay S, Kapoor A, Lattouf JB, Lavallée L, Fairey A, Finelli A, Bhindi B, Kawakami J, Rendon R, Bansal RK. Prognostic significance of extent of venous tumor thrombus in patients with non-metastatic renal cell carcinoma: Results from a Canadian multi-institutional collaborative. Urol Oncol 2021; 39:836.e19-836.e27. [PMID: 34556430 DOI: 10.1016/j.urolonc.2021.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The prognostic significance of level of venous tumor thrombus (VTT) extension in patients with non-metastatic renal cell carcinoma (RCC) has been controversial. The aim of this study was to examine the prognostic significance of VTT extent in patients who underwent surgery for non-metastatic RCC. MATERIALS AND METHODS The Canadian Kidney Cancer information system database was used to identify patients who underwent surgery for non-metastatic RCC and VTT from January 2011 to December 2019. Association between VTT level and recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) was examined. Univariable and multivariable analyses were performed to estimate predictors of survival. RESULTS Out of 6,340 patients during the study period, 228 patients (3.6%) had VTT. VTT was level 0 in 84 (37%), level I to II in 112 (49%), and level III to IV in 33 (14%) patients as per the Mayo Clinic classification. Median age was 65.4 years (interquartile range [IQR] 57.6-72.2) and 169 (74.1%) were male. After a median follow-up of 21.2 months, VTT level did not significantly impact the RFS, CSS, or OS. For VTT level 0, I to II, and III to IV, there was no significant difference in estimated 5-year RFS (31%, 23%, and 30.5%; P > 0.05), CSS (70%, 69%, and 55%; P > 0.05) and OS (64%, 66%, and 50%; P > 0.05). Adjusting for known prognostic factors, thrombus level was not associated with risk of recurrence or death. CONCLUSION In a large, multi-institutional cohort of patients undergoing surgery for non-metastatic RCC with tumor thrombus, thrombus extent was not independently associated with recurrence or death.
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Affiliation(s)
- Benjamin Shiff
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Frédéric Pouliot
- Division of Urology, Université Laval, Quebec City, Quebec, Canada
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, British Columbia, Canada, Vancouver
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, Quebec, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | | | - Luke Lavallée
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | - Adrian Fairey
- Division of Urology, University of Alberta, Edmonton, Alberta, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Bimal Bhindi
- Section of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Jun Kawakami
- Section of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rahul K Bansal
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada.
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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. [PMID: 34465952 PMCID: PMC8388349 DOI: 10.4103/iju.iju_13_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/04/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Shitangsu Kakoti
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rahul Jena
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anil Mandhani
- Department of Urology and Renal Transplant, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Uday Pratap Singh
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Zapała Ł, Sharma S, Kunc M, Zapała P, Kłącz J, Korczyński P, Lipowski M, Późniak M, Suchojad T, Drewa T, Matuszewski M, Radziszewski P. Analysis of Clinicopathological Factors Influencing Survival in Patients with Renal Cell Carcinoma and Venous Tumor Thrombus. J Clin Med 2021; 10:jcm10173852. [PMID: 34501296 PMCID: PMC8432091 DOI: 10.3390/jcm10173852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 12/04/2022] Open
Abstract
This study aimed to define patients with renal cell cancer and coexisting tumor thrombus in order to address concerns regarding survival and prognostic factors after radical surgery. Several prognostic factors for overall survival (OS) were assessed in patients treated surgically at five institutions from 2012 to 2018. Univariate and multivariate analyses were used to determine the independent risk factors of OS. A total of 142 patients were eligible for further analysis (mean age of 64.75 years, 56% males). Most patients presented with clear cell carcinoma (95%). The Mayo stage was predominantly 0–1 (88%). Distant visceral metastases at the time of diagnosis were present in 36 patients (25%), whereas nodal metastases were present in 24 patients (16.9%). During the follow-up period (mean of 32.5 months), the 3-year OS rate reached 68.2%. The majority of patients received no adjuvant treatment (n = 107). In a multivariable model predicting OS, regional lymph node status (p < 0.001), distant metastases (p = 0.009), tumor grade (p = 0.002), duration of hospitalization (p = 0.016), and Clavien–Dindo grade (p = 0.047) were identified as independent prognostic factors. A subgroup of patients with specific clinicopathological factors may benefit most from the radical surgery, including patients without regional lymph node or distant metastases and with low tumor grades, whereas short hospitalization and low Clavien–Dindo grades represent additional independent prognostic factors.
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Affiliation(s)
- Łukasz Zapała
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, Poland; (S.S.); (P.Z.); (P.R.)
- Correspondence: (Ł.Z.); (M.K.)
| | - Sumit Sharma
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, Poland; (S.S.); (P.Z.); (P.R.)
| | - Michał Kunc
- Department of Pathomorphology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
- Correspondence: (Ł.Z.); (M.K.)
| | - Piotr Zapała
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, Poland; (S.S.); (P.Z.); (P.R.)
| | - Jakub Kłącz
- Department of Urology, Faculty of Medicine, Medical University of Gdańsk, 80-402 Gdańsk, Poland; (J.K.); (M.M.)
| | - Piotr Korczyński
- Department of Urology, Regional Specialist Hospital, 26-060 Czerwona Góra, Poland; (P.K.); (T.S.)
| | - Michał Lipowski
- Department of Urology, St. Lukas Specialist Hospital, 26-200 Końskie, Poland;
| | - Michał Późniak
- Clinic of Urology, Dr Jurasz University Hospital, 85-094 Bydgoszcz, Poland; (M.P.); (T.D.)
| | - Tomasz Suchojad
- Department of Urology, Regional Specialist Hospital, 26-060 Czerwona Góra, Poland; (P.K.); (T.S.)
| | - Tomasz Drewa
- Clinic of Urology, Dr Jurasz University Hospital, 85-094 Bydgoszcz, Poland; (M.P.); (T.D.)
| | - Marcin Matuszewski
- Department of Urology, Faculty of Medicine, Medical University of Gdańsk, 80-402 Gdańsk, Poland; (J.K.); (M.M.)
| | - Piotr Radziszewski
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, Poland; (S.S.); (P.Z.); (P.R.)
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Surgical Resection of Tumors Invading the Inferior Vena Cava at the Hepatic Vein and Thoracic Levels. World J Surg 2021; 45:3174-3182. [PMID: 34218311 DOI: 10.1007/s00268-021-06227-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Our aim was to describe the results of our program of surgical resection of tumors invading the inferior vena cava (IVC) at the hepatic and thoracic levels. We hypothesized that similar surgical outcomes may be obtained compared to tumor resection below the hepatic vein level if the liver function was preserved. METHODS We performed a single-center retrospective study of 72 consecutive patients who underwent surgical resection from 1996 to 2019 for tumors invading the IVC. We compared two groups based on tumor location below (group I/II) or above (group III/IV) the inferior limit of hepatic veins. RESULTS Tumor histology was similarly distributed between groups. In group III/IV (n = 35), sterno-laparotomy was used in 83% of patients, cardiopulmonary bypass in 77%, and deep hypothermic circulatory arrest in 17%; 23% underwent liver resection. Corresponding proportions in group I/II were 3%, 0%, 0%, and 8%. In group III/IV, 4 patients required emergency resection. Mortality on day 30 was 17% (n = 6) in group III/IV and 0% in group I/II (P = 0.01). There was no liver failure among the 66 postoperative survivors and 5 out of 6 patients who died postoperatively presented a preoperative or postoperative liver failure (P < 0.001). Overall survival was not significantly different between groups with a median follow-up of 15.1 months. R0 resection was achieved in 66% of group I/II and 49% of group III/IV patients (P = 0.03). CONCLUSION Surgical resection of tumors invading the inferior vena cava at hepatic vein and thoracic levels should be reserved to carefully selected patients without preoperative liver failure to minimize postoperative mortality.
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22
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Watanabe S, Ishihara H, Takagi T, Kondo T, Ishiyama R, Fukuda H, Yoshida K, Iizuka J, Kobayashi H, Ishida H, Tanabe K. Impact of sarcopenia on post-operative outcomes following nephrectomy and tumor thrombectomy for renal cell carcinoma with inferior vena cava thrombus. Jpn J Clin Oncol 2021; 51:819-825. [PMID: 33558883 DOI: 10.1093/jjco/hyaa275] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/29/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Sarcopenia is associated with oncological outcomes in various types of cancer. However, the impact of sarcopenia in renal cell carcinoma with inferior vena cava thrombus remains unclear. We herein evaluated the prognostic significance of sarcopenia for renal cell carcinoma with inferior vena cava thrombus following nephrectomy and thrombectomy. METHODS Patients who underwent nephrectomy and thrombectomy for renal cell carcinoma with inferior vena cava thrombus at our department between 2004 and 2019 were retrospectively evaluated. Their sarcopenic status, determined by sex, body mass index and skeletal muscle index, was calculated using pre-surgical radiographic imaging. We compared the post-operative cancer-specific survival and overall survival, surgical data and duration of post-operative hospitalization of sarcopenic and non-sarcopenic patients. RESULTS Out of 83 patients, 54 (65%) were sarcopenic. Sarcopenic patients had significantly shorter cancer-specific survival (median: 33.3 months vs. not reached, P = 0.0323) and overall survival (32.0 months vs. not reached, P = 0.0173) than non-sarcopenic patients. Furthermore, multivariate analyses showed that sarcopenia was an independent factor for cancer-specific survival (hazard ratio: 2.76, P = 0.0212) and overall survival (hazard ratio: 2.93, P = 0.014). The incidence rate of surgical complications (any grade: 35.2% vs. 27.6%, P = 0.482; grades ≥ 3: 7.4% vs. 10.3%, P = 0.648) or duration of post-operative hospitalization (median: 11 vs. 10 days, P = 0.148) was not significantly different between sarcopenic and non-sarcopenic patients. CONCLUSIONS In conclusion, this study showed that sarcopenia was an independent prognostic factor for renal cell carcinoma with inferior vena cava thrombus after nephrectomy and tumor thrombectomy. Thus, sarcopenia evaluation can be utilized as an effective prognosticator of post-operative survival.
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Affiliation(s)
- Shun Watanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Ryo Ishiyama
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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Onal B, Simsekoglu MF, Gultekin MH, Demirdag C, Citgez S, Erozenci A. Clinical outcomes of radical surgery in patients with renal carcinoma and associated venous thrombosis: Single-centre experience in a tertiary care institution. Int J Clin Pract 2021; 75:e13811. [PMID: 33131122 DOI: 10.1111/ijcp.13811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Renal carcinoma and associated venous thrombosis cause specific perioperative and postoperative challenges. We aimed to evaluate the factors affecting clinical outcomes in patients undergoing radical surgery because of renal carcinoma and associated venous thrombosis. MATERIALS AND METHODS Hospital records were retrospectively reviewed to identify patients with renal carcinoma and associated venous thrombosis treated with radical surgery between 2006 and 2019. Preoperative, perioperative, and postoperative findings were analysed to determine the associations between clinical and survival outcomes. Overall and disease-free survival were analysed by the Kaplan-Meier method. Other associated prognostic variables were assessed using univariate and multivariate Cox regression analyses. RESULTS Thirty-three patients with renal carcinoma and associated venous thrombosis were enrolled for this study. There were 15 (45.4%) patients with level I, five (15.2%) with level II, eight (24.2%) with level III, and five (15.2%) with level IV venous thrombosis according to the Mayo Clinic classification system. The median follow-up was 35.6 months. In the univariate analysis, increased tumour size was associated with poor overall and disease-free survival. Preoperative clinic M1 disease was associated with poor overall survival. A high Mayo Clinic thrombus level was associated with poor disease-free survival. In the multivariate analysis, only tumour size and clinic M1 disease were independently correlated with poor overall survival. No independent statistically significant association was detected between thrombus level and survival outcomes. CONCLUSIONS Although the thrombus level was not associated with overall and disease-free survival, tumour size and clinic M1 disease were found to have an independent prognostic impact on overall survival.
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Affiliation(s)
- Bulent Onal
- Department of Urology, Cerrahpasa School of Medicine, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Muhammed Fatih Simsekoglu
- Department of Urology, Cerrahpasa School of Medicine, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Hamza Gultekin
- Department of Urology, Cerrahpasa School of Medicine, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Cetin Demirdag
- Department of Urology, Cerrahpasa School of Medicine, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Sinharib Citgez
- Department of Urology, Cerrahpasa School of Medicine, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Erozenci
- Department of Urology, Cerrahpasa School of Medicine, University of Istanbul-Cerrahpasa, Istanbul, Turkey
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Jin H, Zhang M, Jin K, Hu C. Adjuvant targeted therapy combined with surgery for advanced and metastatic renal cell carcinoma: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2021; 100:e23956. [PMID: 33545974 PMCID: PMC7838006 DOI: 10.1097/md.0000000000023956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this systematic review and meta-analysis is to evaluate the efficacy and safety of adjuvant targeted therapy by sunitinib combined with surgery in the treatment of advanced or metastatic renal cell carcinoma. METHODS PubMed/Medline, Web of Science, Cochrane Library, ClinicalTrials.gov (http://www.ClinicalTrials.gov), China National Knowledge Infrastructure (CNKI) will be searched for clinical research articles related to the efficacy and safety of adjuvant therapy combined with surgery in the treatment of advanced and metastatic RCC. The identification, inclusion and exclusion flow charts will be conducted according to the PRISMA guidelines. The quality assessment will be done by Quadas-2 evaluation tool. Key parameters including OS in 10, 20, 30, and 40 months, PFS in 10, 20, and 30 months, objective response rate (ORR), stable disease (SD) rate, progressive disease (PD) rate, median OS and PFS, types of AEs and their occurrence rates, etc will be extracted. The evaluation of the efficacy and safety will be pooled by CMA. RESULTS This systematic review will provide evidence on the efficacy and safety of adjuvant therapy by sunitinib combined with surgery in treating advanced and metastatic RCC. CONCLUSION The study aims to generalize data concerning the response rate, OS, PFS and rates of adverse effects of the perioperative use of sunitinib in advanced and metastatic RCC patients. The evidence provided by this systematic review and meta-analysis will help guide the clinical decision making and enlighten the future management of advanced or metastatic RCC. REGISTRATION This protocol has been registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY registration number: INPLASY2020110093; INPLASY DOI number: 10.37766/inplasy2020.11.0093 Available at: https://inplasy.com).
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Affiliation(s)
- Hongyu Jin
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu
| | - Man Zhang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University; Key Laboratory of Obstetric & Gynecologic and Pediatric Disease and Birth Defects of Ministry of Education
| | - Kun Jin
- Department of Urology, Institute of Urology
| | - Chenggong Hu
- Department of Critical Care Unit, West China Hospital, Sichuan University, Chengdu, China
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Kalapara AA, Frydenberg M. The role of open radical nephrectomy in contemporary management of renal cell carcinoma. Transl Androl Urol 2020; 9:3123-3139. [PMID: 33457285 PMCID: PMC7807349 DOI: 10.21037/tau-19-327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Radical nephrectomy (RN) remains a cornerstone of the management of localised renal cell carcinoma (RCC). RN involves the en bloc removal of the kidney along with perinephric fat enclosed within Gerota's fascia. Key principles of open RN include appropriate incision for adequate exposure, dissection and visualisation of the renal hilum, and early ligation of the renal artery and subsequently renal vein. Regional lymph node dissection (LND) facilitates local staging but its therapeutic role remains controversial. LND is recommended in patients with high risk clinically localised disease, but its benefit in low risk node-negative and clinically node-positive patients is unclear. Concomitant adrenalectomy should be reserved for patients with large tumours with radiographic evidence of adrenal involvement. Despite a recent downtrend in utilisation of open RN due to nephron-sparing and minimally invasive alternatives, there remains a vital role for open RN in the management of RCC in three domains. Firstly, open RN is important to the management of large, complex tumours which would be at high risk of complications if treated with partial nephrectomy (PN). Secondly, open RN plays a crucial role in cytoreductive nephrectomy (CN) for metastatic RCC, in which the laparoscopic approach achieves similar results but is associated with a high reoperation rate. Finally, open RN is the current standard of care in the management of inferior vena caval (IVC) tumour thrombus. Management of tumour thrombus requires a multidisciplinary approach and varies with cranial extent of thrombus. Higher level thrombus may require hepatic mobilisation and circulatory support, whilst the presence of bland thrombus may warrant post-operative filter insertion or ligation of the IVC.
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Affiliation(s)
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Australia.,Cabrini Institute, Cabrini Health, Melbourne, Australia
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Nason GJ, Ajib K, Tan GH, Woon DTS, Christakis GT, Nam RK. Radical nephrectomy with resection of vena cava thrombus using extracorporeal circulation and deep hypothermic circulatory arrest. Can Urol Assoc J 2020; 15:E199-E204. [PMID: 33007182 DOI: 10.5489/cuaj.6736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patients with renal cell carcinoma (RCC) with level 3 or 4 caval thrombus have a poor prognosis, with reported five-year survival rates of 30-40%. The aim of this study was to assess the perioperative morbidity and long-term oncological outcomes for radical nephrectomy with resection of vena cava thrombus using a combined surgical approach, including extracorporeal circulation and deep hypothermic circulatory arrest. METHODS A retrospective review was performed of the institutional case log to identify all radical nephrectomies with caval thrombus performed from January 2006 to May 2020. RESULTS Twenty-five patients were identified with level 2 thrombus in one (4%), level 3 thrombus in eight (32%), and level 4 in 16 (64%). The median followup was 20.6 months (range 0.2-133.3). The median age at surgery was 68.4 years (range 44.2-85.5). Twenty-one (84%) patients were symptomatic at presentation. Six (24%) patients had distant metastases at diagnosis. The median circulatory arrest time was 15 minutes (range 6-35). The 30-day grade ≥3 complication rate was 8%. The 30-day mortality rate was 8%. The one-year, two-year, three-year, and five-year recurrence-free survival (RFS) rates were 53%, 18%, 10%, and 10%, respectively. The median time to systemic treatment was 7.7 months (range 1.2-25.7). The one-year, two-year, three-year, and five-year overall survival (OS) rates were 70%, 43%, 36%, and 31%, respectively. CONCLUSIONS Radical nephrectomy with resection of vena cava thrombus using extracorporeal circulation and deep hypothermic circulatory arrest is associated with some morbidity and mortality but remains a safe and effective strategy for advanced RCC patients who would otherwise be managed palliatively.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Khaled Ajib
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Guan Hee Tan
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Dixon T S Woon
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - George T Christakis
- Division of Cardiac Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Robert K Nam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
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Rivero Belenchón I, Congregado Ruíz CB, Gómez Ciriza G, Gómez Dos Santos V, Rivas González JA, Gálvez García C, González Gordaliza MC, Osmán García I, Conde Sánchez JM, Burgos Revilla FJ, Medina López RA. How to obtain a 3D printed model of renal cell carcinoma (RCC) with venous tumor thrombus extension (VTE) for surgical simulation (phase I NCT03738488). Updates Surg 2020; 72:1237-1246. [DOI: 10.1007/s13304-020-00806-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
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Rosenfeld BL, Bashir R, Brisco-Bacik MA, Panidis IP, Vaidya A, Minakata K, Forfia PR. Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e921124. [PMID: 32345956 PMCID: PMC7209904 DOI: 10.12659/ajcr.921124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tumor embolism is a rare neoplastic complication that occurs when there is intravenous invasion by a benign or malignant tumor. We present the case of an asymptomatic patient with an incidentally discovered leiomyosarcoma tumor emboli, which was initially misdiagnosed as "thrombus in transit." CASE REPORT The patient was a 58-year-old woman who was incidentally found on echocardiogram to have a large tubular mass within the inferior vena cava and right atrium. Although initially characterized as "thrombus in transit", this mobile right atrial mass was present without clinical, echocardiographic, or radiographic evidence of pulmonary embolism or increased pulmonary arterial impedance. Given that a thrombus in transit is nearly always associated with submassive or massive pulmonary emboli and their attendant right heart sequelae, these pertinent negative findings led us to seek an alternative diagnosis. After a trial of conservative management with anticoagulation and attempted removal of the mass with the AngioVac system, the patient ultimately underwent median sternotomy and surgical embolectomy on cardiopulmonary bypass to remove the mass, which was later identified on pathology as a leiomyosarcoma. CONCLUSIONS With rare exceptions, "thrombus in transit" is accompanied by large pulmonary emboli and the presence of increased pulmonary artery pressure and right heart strain. The absence of clinical, echocardiographic, or radiographic evidence of these hemodynamic sequelae should raise suspicion for an alternative diagnosis. Tumor embolism should be considered in the differential diagnosis of any patient with a history of malignancy who presents with evidence of intracardiac mass or embolism.
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Affiliation(s)
- Benjamin L Rosenfeld
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Riyaz Bashir
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
| | | | - Ioannis P Panidis
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
| | - Anjali Vaidya
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
| | - Kenji Minakata
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Paul R Forfia
- Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA
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Miao C, Wang Y, Hou C, Chen W, Xu A, Wang Z. Comprehensive managements of metastatic renal tumor with Mayo III inferior vena cava tumor thrombus: a case report. Transl Androl Urol 2020; 9:812-818. [PMID: 32420189 PMCID: PMC7215005 DOI: 10.21037/tau.2019.12.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Renal tumor with inferior vena cava (IVC) tumor thrombus still remains one of the most medical challenges in urological oncology. Despite numerous researches reporting the surgical experiences and survivals of this kind of patients, there is still lacking a standard recommended therapy right now. We reported a case of metastatic renal cell carcinoma with Mayo III IVC tumor thrombus who underwent robotic-assisted complete removal of the intracaval thrombus and radical left nephrectomy followed by renal arterial chemoembolization and pazopanib administration. It provides a new scheme and mode of diagnosis and treatment for this kind of patients. The patient was a 50-year-old man with left low-back pain for 20 days diagnosed with left renal tumor and Mayo III IVC tumor thrombus at the earliest. Initially, the patient underwent the renal arterial chemoembolization and targeted treatment to inhibit tumor's progression. After a two-year therapy period, the size of renal mass and lung nodules decreased than before, as well as the IVC tumor thrombus dropped to level II. Considering the efficacy of previous treatments, we performed robot-assisted IVC thrombectomy and radical left nephrectomy for this patient. The post-operative pathological examination confirmed the diagnosis of tumor thrombus as renal clear cell carcinoma. The patients recovered well after surgery and was followed-up for 36 months during the whole treatment course. This case with metastatic renal cell carcinoma (mRCC) and Mayo III IVC tumor thrombus received the interventional therapy, molecular targeted therapy and robot-assisted surgery successively, and acquired satisfying outcome. Patients with mRCC always suffer shorter overall survivals and aggressive progression compared with those localized tumors, therefore it is essential to formulate rational comprehensive treatment and carry out in time following-up.
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Affiliation(s)
- Chenkui Miao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yuhao Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Chao Hou
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wen Chen
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Aiming Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Pani S, Kelsh-Lasher R, Barlin J, Darling RC, Torosoff M, Kaufman RP. Use of Transesophageal Echocardiogram and Interdisciplinary Approach to Intraoperative Management of Renal Cell Carcinoma With Inferior Vena Cava Invasion. J Cardiothorac Vasc Anesth 2019; 34:995-1001. [PMID: 31780356 DOI: 10.1053/j.jvca.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/13/2019] [Accepted: 10/02/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Report experience of patients undergoing surgery for resection of renal cell carcinoma with inferior vena cava invasion and use of transesophageal echocardiogram (TEE). DESIGN Retrospective and observational study. SETTING Single large university hospital. PARTICIPANTS The study comprised 55 consecutive who underwent resection of renal cell carcinoma. INTERVENTIONS A transesophageal echocardiogram was performed by cardiac anesthesiologists in high grade tumors. MEASUREMENTS AND MAIN RESULTS Twenty-two patients had tumor thrombi classified as level III, and 6 patients were classified as level IV. There was increased use of TEE for higher level of tumor thrombi. CONCLUSIONS The surgical management of renal cell carcinoma with inferior vena cava tumor extension is complex. High-grade tumors require individualized treatment. Successful outcomes require collaboration between surgeons and anesthesiologists. Patients with level IIIb to IV tumor invasion benefit from TEE assessment and monitoring, which may be life-saving, and cardiac anesthesia should be involved in those types of cases.
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Affiliation(s)
- Saroj Pani
- Department of Anesthesiology, Albany Medical Center, Albany, NY.
| | | | - Joanne Barlin
- Department of Anesthesiology, Albany Medical Center, Albany, NY
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Ge L, Tian X, Ma J, Zhao G, Song Y, Zhang S, Ma L. Surgical treatment for Xp11.2 translocation renal cell carcinoma with venous thrombus: A STROBE-compliant study. Medicine (Baltimore) 2019; 98:e17172. [PMID: 31517871 PMCID: PMC6750303 DOI: 10.1097/md.0000000000017172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The aim of the study was to report the experience and outcomes of Xp11.2 translocation renal cell carcinoma (tRCC) patients with tumor thrombus undergoing radical nephrectomy and thrombectomy.Between January 2017 and December 2017, 66 consecutive patients with RCC and venous thrombus involvement received surgical treatment at Peking University Third Hospital. Of which, 5 patients were confirmed of Xp11.2 tRCC, 61 patients were diagnosed of non-tRCC subtypes including 45 ccRCCs, 10 pRCCs, and 6 other subtypes. Demographic, clinical, operation, pathological and follow-up data were extracted for analysis. Prognostic factors were identified by Cox regression analysis.All the patients received radical nephrectomy and thrombectomy successfully. During a median follow-up of 18 months, 5 patients in non-tRCC group and 1 patient in tRCC group died of disease progression. Survival analysis revealed that Xp11.2 tRCC patients experienced shorter DFS than non-tRCC patients, however, there is no significant difference in OS between two groups. Xp11.2 tRCC histological subtype and presence of metastasis at diagnosis were identified as independent negative factors of DFS by multivariate analysis.Radical nephrectomy with thrombectomy provides an acceptable efficacy for tRCC patients with tumor thrombus extending into the venous system. In addition, multimodality treatment should be considered for advanced Xp11.2 RCCs as this subtype was a negative prognostic factor of DFS.
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Affiliation(s)
| | | | - Jing Ma
- Department of Ultrasonography, Peking University Third Hospital, Haidian District, Beijing, PR China
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Park H, Jeong CW, Yuk H, Ku JH, Kim HH, Kwak C, Kim I. Influence of Tumor Thrombus on Occurrence of Distant Venous Thromboembolism and Survival in Patients With Renal Cell Carcinoma After Surgery. Clin Appl Thromb Hemost 2019; 25:1076029618823288. [PMID: 30808214 PMCID: PMC6714931 DOI: 10.1177/1076029618823288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Tumor thrombus is a unique characteristic of renal cell carcinoma (RCC). However, only a few studies have reported its clinical influence on the occurrence of venous thromboembolism (VTE). This study aimed to clarify the influence of tumor thrombus and other risk factors for VTE and to elucidate the impact of tumor thrombus on survival outcomes. We retrospectively reviewed data from patients with RCC who underwent radical or partial nephrectomy from September 1999 to August 2015 at Seoul National University Hospital. A total of 2762 patients were enrolled. The 1- and 5-year cumulative incidences of VTE were 0.5% ± 0.1% and 1.5% ± 0.3%, respectively. During a median follow-up of 39.0 months (95% confidence interval [CI], 37.1-41.0 months), deep vein thrombosis occurred in 13 patients and pulmonary embolism in 15 patients. Patients with tumor thrombus (diagnosed by surgical pathology findings) had a significantly higher incidence of VTE than those without thrombus (odds radio 8.160, 95% CI, 1.480-45.004). Older age (≥60 years) and higher preoperative C-reactive protein (>0.5 mg/dL) were also significant risk factors for VTE. Additionally, tumor thrombus was independently associated with worse progression-free survival (PFS) but not with overall survival (OS) in multivariable analysis (hazard ratio [HR] 1.916, 95% CI, 1.295-2.834 for PFS; HR 1.164, 95% CI, 0.755-1.793 for OS). In conclusion, the incidence of VTE was relatively low in patients who underwent surgery for RCC. Nevertheless, patients with tumor thrombus had an increased risk of VTE and should be closely monitored for VTE.
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Affiliation(s)
- Hyunkyung Park
- 1 Department of Internal Medicine, Division of Hematology/Medical Oncology, Seoul National University College of Medicine, Seoul, South Korea
| | - Chang Wook Jeong
- 2 Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeongdong Yuk
- 2 Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja Hyeon Ku
- 2 Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Cheol Kwak
- 2 Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Inho Kim
- 1 Department of Internal Medicine, Division of Hematology/Medical Oncology, Seoul National University College of Medicine, Seoul, South Korea.,3 Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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Ralla B, Adams L, Maxeiner A, Mang J, Krimphove M, Dushe S, Makowski M, Miller K, Fuller F, Busch J. Perioperative and oncologic outcome in patients treated for renal cell carcinoma with an extended inferior vena cava tumour thrombus level II-IV. Aktuelle Urol 2019; 53:431-438. [PMID: 31163462 DOI: 10.1055/a-0919-4043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Surgical treatment of patients with renal cell carcinoma (RCC) and an extended tumour thrombus (TT) in the inferior vena cava (IVC) is challenging and often requires a multidisciplinary approach. The aim of this study was to analyse results in the real-world management of RCC patients with an extended IVC TT (level II-IV according to the Mayo classification of macroscopic venous invasion in RCC) in terms of pre-, peri- and postoperative outcome, complications and oncologic outcome. METHODS We investigated 61 patients with evidence of RCC and an extended TT in the IVC undergoing radical nephrectomy and tumour thrombectomy at our tertiary referral centre. Patients and operative characteristics were recorded and complications were analysed using the Clavien-Dindo classification. Follow-up data were retrieved by contacting the treating outpatient urologists, general practitioners and patients. RESULTS The TT level was II in 36, III in 8 and IV in 17 patients. Complications grade IIIb and higher according to the Clavien-Dindo classification occurred in n = 3 (8.4 %), n = 2 (25.0 %) and n = 5 (29.5 %) patients with level II, III and IV TT, respectively. The overall survival of patients with TT level II, III and IV at 24 months (60 months) was 66.9 % (41.6 %), 83.3 % (83.3 %) and 64.1 % (51.3 %). Presence of primary metastatic disease was the only significant independent predictor for OS. CONCLUSIONS: Radical nephrectomy with tumour thrombectomy appears to be a feasible and effective treatment option in the management of patients with RCC and an extended IVC TT.
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Affiliation(s)
| | - Lisa Adams
- Charité – Universitätsmedizin Berlin, Radiologie, Berlin
| | | | - Josef Mang
- Charité – Universitätsmedizin Berlin, Urologie, Berlin
| | | | - Simon Dushe
- Charité – Universitätsmedizin Berlin, Herzchirurgie, Berlin
| | | | - Kurt Miller
- Charité – Universitätsmedizin Berlin, Urologie, Berlin
| | | | - Jonas Busch
- Charité – Universitätsmedizin Berlin, Urologie, Berlin
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Huang J, Lü S, Hu Z, Huang C, Li Y, Wei Q. [Three-dimensional reconstruction of human kidney based on UroMedix-3D system and its application in kidney surgery]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:614-620. [PMID: 31140429 DOI: 10.12122/j.issn.1673-4254.2019.05.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore the feasibility of rapid and accurate three-dimensional (3D) image reconstruction using Uromedix-3D software for urological surgery. METHODS The original renal thin-slice enhancement CT data were obtained from patients with kidney lesions treated in our hospital between December, 2015 and October, 2018. The self-developed Uromedix- 3D system was used to reconstruct the normal kidney structures, blood vessels, collecting systems and the lesions. The spatial anatomic relationships of the structures were measured and digitized for surgical planning. RESULTS 3D reconstruction of the kidneys was performed in a total of 173 cases, and the mean time for reconstruction was 31.24±2.012 min. Of these cases, 147 (84.9%) had renal tumors, and 2 had renal tumors with tumor thrombus. In addition to renal tumors, the Uromedix-3D system was also used for reconstructing other lesions including UPJO, kidney stones and retroperitoneal masses. Renal artery reconstruction was performed in 170 cases, which allowed observation of the precise terminal branches (up to 7th grade arterial branch) of the artery; 109 (64%) cases showed the 5th grade arterial branch or above. Renal artery variations were detected in 37 cases, including accessory renal artery (24 cases) and multiple renal arteries (13 cases). The renal veins were reconstructed in 164 cases, and second grade or above (up to the 4th grade) vein branches were observed in 138 (84%) cases. CONCLUSIONS Uromedix-3D system can accurately and efficiently reconstruct the 3D structure of human kidneys and the renal lesions based on enhanced CT data. The reconstructed 3D model allows objective assessment of the spatial anatomical relationship of the lesions to provide assistance in surgical planning.
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Affiliation(s)
| | - Shidong Lü
- Department of Urology, Guangzhou 510515, China
| | - Zhengfei Hu
- Department of Urology, Guangzhou 510515, China
| | - Chantao Huang
- Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yiwen Li
- Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Qiang Wei
- Department of Urology, Guangzhou 510515, China
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Jin H, Zhang J, Shen K, Hao J, Feng Y, Yuan C, Zhu Y, Ma X. Efficacy and safety of perioperative appliance of sunitinib in patients with metastatic or advanced renal cell carcinoma: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15424. [PMID: 31096438 PMCID: PMC6531174 DOI: 10.1097/md.0000000000015424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this systematic review and meta-analysis is to comprehensively evaluate the efficacy and safety of the perioperative use of sunitinib in patients with metastatic and advanced renal cell carcinoma (RCC). MATERIALS AND METHODS We searched authenticated databases for related clinical studies. The baseline characteristics, parameters concerning the efficacy and safety of the perioperative use of sunitinib were extracted for subsequent comprehensive analysis. The parameters which reflected the efficacy and safety as overall survival (OS), progression-free survival (PFS), occurrence rate of all-grade and grade ≥3 adverse effects (AEs) were carefully pooled using comprehensive meta-analysis. RESULTS We finally recruited 411 patients from 14 eligible studies. We found proteinuria (75.0%, 95% CI 62.1%-84.6%), anemia (71.6%, 95% CI 60.9%-80.3%), athesia (60.0%, 95% CI 40.3%-77.0%), pause symptoms (59.2%, 95% CI 49.2%-68.4%), arterial hypertension (53.1%, 95% CI 43.2%-62.7%), and thrombocytopenia (52.5%, 95% CI 44.8%-60.0%) to be the most common all-grade AEs. And arterial hypertension, athesia, cutaneous toxicity, hypophosphatemia, leukopenia, pain, pause syndrome, renal dysfunction, and thrombocytopenia were the most common types of grade ≥3 AEs. In addition, objective response rate (ORR) of sunitinib to both the original and metastatic tumor sites increased with the use of sunitinib, so did the OS and PFS. CONCLUSION Common all-grade and grade ≥3 AEs were carefully monitored. The perioperative use of sunitinib showed superior ORR, OS, and PFS rates. Nevertheless, more studies are required to further verify these findings.
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Affiliation(s)
- Hongyu Jin
- Department of Biotherapy and Cancer Center, State Key Laboratory of Biotherapy, West China Hospital
- West China School of Medicine
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jing Zhang
- Department of Biotherapy and Cancer Center, State Key Laboratory of Biotherapy, West China Hospital
- West China School of Medicine
| | - Kai Shen
- Department of Biotherapy and Cancer Center, State Key Laboratory of Biotherapy, West China Hospital
- West China School of Medicine
| | | | | | | | | | - Xuelei Ma
- Department of Biotherapy and Cancer Center, State Key Laboratory of Biotherapy, West China Hospital
- West China School of Medicine
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Rehman ZU, Ather MH, Aziz W. Surgical Interventions for Renal Cell Carcinoma with Thrombus Extending into the Inferior Vena Cava: A Multidisciplinary Approach. Ann Vasc Dis 2019; 12:55-59. [PMID: 30931058 PMCID: PMC6434349 DOI: 10.3400/avd.oa.18-00150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess surgical strategies and the impact of a multidisciplinary approach on patients undergoing inferior vena caval thrombectomy for renal cell carcinoma and to evaluate perioperative morbidity and mortality associated with these procedures. Methodology: A retrospective audit for all adults who underwent nephrectomy and inferior vena caval thrombectomy from January 2008 till November 2018 at a University hospital. Patients with incomplete records were excluded from the study. Results: During the study period, 21 patients underwent inferior vena caval thrombectomy as a completion of radical nephrectomy. Most were males (19 : 2) with a mean age of 54±11.3 years. The most common surgical approach was the 11th rib flank approach (n=8) followed by midline abdominal (n=6) and Mercedes-Benz (n=5). Eight patients had level 1, 10 patients had level 2, and three patients had level 3 tumour thrombus. The cavotomy was closed primarily in 20 patients; one required inferior vena cava (IVC) reconstruction with a pericardial patch. The proximal clamp was applied below the hepatic veins for most patients. Two patients required suprahepatic clamping before thrombectomy. There was no intraoperative mortality. Five patients (24%) developed complications: two required cardiopulmonary resuscitation due to severe hypotension and were revived; one developed acute renal failure; and one patient required a damage control laparotomy for excessive oozing. There was no thirty-day mortality. Conclusion: The IVC thrombectomy, along with radical nephrectomy for renal cell carcinoma for 1–3 level thrombus, can be performed with acceptable morbidity in a multidisciplinary team approach.
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Affiliation(s)
- Zia Ur Rehman
- Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - M Hammad Ather
- Section of Urology, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Wajahat Aziz
- Section of Urology, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Radical nephrectomy and intracaval thrombectomy for advanced renal cancer with extensive inferior vena cava involvement utilising cardiopulmonary bypass and hypothermic circulatory arrest: Is it worthwhile? Arab J Urol 2018; 16:378-385. [PMID: 30534435 PMCID: PMC6277273 DOI: 10.1016/j.aju.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/14/2018] [Accepted: 06/23/2018] [Indexed: 11/21/2022] Open
Abstract
Objective To report our long-term outcomes of surgical treatment of renal tumours with inferior vena cava (IVC) tumour thrombus above the hepatic veins, utilising cardiopulmonary bypass (CBP) and hypothermic circulatory arrest (HCA), as surgical resection remains the only effective treatment for renal cancers with extensive IVC tumour thrombus. Patients and methods We retrospectively reviewed 48 consecutive patients (median age 58 years) who underwent surgical treatment for non-metastatic renal cancer with IVC tumour thrombus extending above the hepatic veins. Perioperative, histological, disease-free (DFS) and overall survival (OS) data were recorded. Results Tumour thrombus was level III in 23 patients and level IV in 25 patients. The median (range) CBP and HCA times were 162 (120-300) min and 35 (9-64) min, respectively. Three patients underwent synchronous cardiac surgical procedures. There were three (6.3%) perioperative deaths. American Society of Anesthesiologists grade and perioperative blood transfusion requirement were significant factors associated with perioperative death (P < 0.05). Despite extensive preoperative screening for metastases the median (range) DFS was only 10.2 (1.2-224.4) months. The median (range) OS was 23 (0-224.4) months. Cox regression analysis revealed that perinephric fat invasion conferred a significantly poorer DFS (P = 0.005). Conclusions Radical surgery for patients with extensive IVC tumour thrombus has acceptable operative morbidity and mortality. It provides symptom palliation and the possibility of long-term survival. Improvements in preoperative detection of occult metastasis may improve case selection and newer adjuvant therapies may improve survival in this high-risk group.
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Master VA, Ethun CG, Kooby DA, Staley CA, Maithel SK. The value of a cross-discipline team-based approach for resection of renal cell carcinoma with IVC tumor thrombus: A report of a large, contemporary, single-institution experience. J Surg Oncol 2018; 118:1219-1226. [PMID: 30332513 DOI: 10.1002/jso.25271] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION We report the evolution of the largest, contemporary, single-institution experience with this complex procedure to highlight the value of a cross-discipline, team-based approach. METHODS Patients from a prospectively maintained database who underwent resection of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus from 2005 to 2016 at a single-institution were included for analysis. RESULTS Of 140 patients, 102 (73%) had tumor thrombus below the level of the hepatic vein confluence, and 96 (69%) were performed for curative-intent, while 43 (31%) were cytoreductive procedures for clinical trial consideration. Median overall survival (OS) of the entire cohort was 43.8 months (5-year OS:43%), and 73.6 months (5-year OS:59%) for those without metastatic disease. Fifty-one patients underwent resection from 2005 to 2010 and 89 from 2011 to 2016. All procedures since 2011 were performed by the same cross-discipline dedicated team of two surgeons, composed of a surgical and urological oncologist. When comparing the two time-periods, the team-approach after 2011 had shorter operative-times (5.3 vs 6.7 hours; P = 0.009), decreased ICU-utilization (25% vs 72%; P < 0.001), and decreased ICU length-of-stay (0.4 vs 2.2 days; P = 0.001). This group also trended towards less blood loss (1.2 vs 1.8 L), shorter average hospital length-of-stay (10 vs 11 days), and decreased 90-day mortality (6% vs 10%). CONCLUSION Resection of RCC with IVC tumor thrombus yields long-term survival. A dedicated, cross-discipline, and team-based approach optimizes patient outcomes and may improve value of care by reducing utilization of expensive hospital resources.
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Affiliation(s)
- Viraj A Master
- Department of Urology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Cecilia G Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - David A Kooby
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Charles A Staley
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Gu L, Li H, Wang Z, Wang B, Huang Q, Lyu X, Shen D, Gao Y, Fan Y, Li X, Xie Y, Du S, Liu K, Tang L, Peng C, Ma X, Zhang X. A systematic review and meta-analysis of clinicopathologic factors linked to oncologic outcomes for renal cell carcinoma with tumor thrombus treated by radical nephrectomy with thrombectomy. Cancer Treat Rev 2018; 69:112-120. [PMID: 29960124 DOI: 10.1016/j.ctrv.2018.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND There remain discrepancies over the factors that influence oncologic outcomes after radical nephrectomy with thrombectomy (RNTE). To assess significant predictors of oncologic outcomes after RNTE from a systematic review and meta-analysis. METHODS A comprehensive search of PubMed, Embase, Cochrane Library and Web of Science was performed to identify eligible studies. The endpoints included cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS). A formal meta-analysis was performed for studies containing non-metastatic and metastatic tumors. Additionally, a sensitivity analysis including the subgroup of studies containing non-metastatic tumors only was conducted. Cumulative analyses of hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were conducted. RESULTS Overall, 35 retrospective studies of low to moderate risk of bias including 11,929 patients were included. The results indicated that large tumor size, high Fuhrman grade, tumor necrosis, positive lymph node, and metastasis at surgery were adverse significant predictors for both CSS and OS. Also, IVC tumor thrombus, sarcomatoid differentiation, perinephretic fat invasion, and adrenal gland invasion were associated with poor CSS. In the subset of non-metastatic patients, the significant predictors were clinical symptom, thrombus level, Fuhrman grade and adrenal gland invasion for CSS; thrombus consistency, Fuhrman grade and tumor necrosis for OS; tumor size, Fuhrman grade and perinephretic fat invasion for RFS. CONCLUSIONS A meta-analysis of available data identified significant prognostic factors of CSS, OS and RFS that should be systematically evaluated to propose a risk-adapted approach to postoperative patient counseling, risk stratification, and therapy selection.
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Affiliation(s)
- Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Zihuan Wang
- Institute of Occupational Health, Beijing Center for Disease Control and Prevention, Beijing, China
| | - Baojun Wang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Qingbo Huang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xiangjun Lyu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Dan Shen
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Yu Gao
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Yang Fan
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xintao Li
- Department of Urology, Chinese Air Force General Hospital, Beijing, China
| | - Yongpeng Xie
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Songliang Du
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Kan Liu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Lu Tang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Cheng Peng
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xin Ma
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
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Pruthi DK, Wang H, Satsangi A, Cajipe M, Iffrig K, Haidar GM, Hicks T, Sako EY, Liss MA, Chowdhury WH, Rodriguez R, Kaushik D. Contemporary surgical outcomes of venous tumour thrombectomy managed with intraoperative Doppler ultrasound for kidney cancer. Can Urol Assoc J 2018; 12:E391-E397. [PMID: 29787368 DOI: 10.5489/cuaj.5013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Radical nephrectomy (RN) with venous tumour thrombectomy (VTT) carries a significant morbidity and mortality risk. Examination of a contemporary single-institution series permits the development of a management algorithm and an audit its results. We report outcomes following the use of intraoperative colour Doppler ultrasound and our surgical pathway. METHODS We retrospectively reviewed the records of all patients who underwent RN with VTT for kidney cancer between January 1, 2013 and October 1, 2016. Surgical complications, postoperative complications (Clavien-Dindo classification ≥3), 90-day readmission rates, and outcomes are reported. Multivariate linear regression, logistic regression, and Cox proportional hazard modelling were used to identify associations. RESULTS Fifty-eight patients underwent RN with VTT. Of these, 26 (45%) patients had Mayo Clinic level III or IV thrombus and nineteen required venovenous/cardiopulmonary bypass. Three patients required patch grafting. The median length of hospital stay was eight days and there were 20 major complications. The 30-day readmission rate was 21% and the 90-day mortality rate was 8.9%. In multivariate analysis, low serum albumin and age-adjusted Charlson comorbidity score predicted length of stay. Increased intraoperative blood loss was significantly associated with increasing body mass index, serum creatinine, tumour thrombus level, and a history of significant weight loss >9.1kg. Low serum hematocrit predicted 90-day mortality. CONCLUSIONS Intraoperative colour Doppler ultrasound is a useful tool and can facilitate caval preservation. Caval grafting can be avoided in most cases. Venovenous bypass can be avoided in many level III cases. Early therapeutic anticoagulation should be instituted with caution.
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Affiliation(s)
| | | | | | | | | | | | | | - Edward Y Sako
- Department of Cardiothoracic Surgery; University of Texas Health San Antonio, San Antonio, TX, United States
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Genomic features of renal cell carcinoma with venous tumor thrombus. Sci Rep 2018; 8:7477. [PMID: 29748622 PMCID: PMC5945671 DOI: 10.1038/s41598-018-25544-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 04/25/2018] [Indexed: 12/17/2022] Open
Abstract
A venous tumor thrombus (VTT) is a potentially lethal complication of renal cell carcinoma (RCC) but virtually nothing is known about the underlying natural history. Based on our observation that venous thrombi contain significant numbers of viable tumor cells, we applied multiregion whole exome sequencing to a total of 37 primary tumor and VTT samples including normal tissue specimens from five consecutive patients. Our findings demonstrate mutational heterogeneity between primary tumor and VTT with 106 of 483 genes (22%) harboring functional SNVs and/or indels altered in either primary tumor or thrombus. Reconstruction of the clonal phylogeny showed clustering of tumor samples and VTT samples, respectively, in the majority of tumors. However, no new subclones were detected suggesting that pre-existing subclones of the primary tumor drive VTT formation. Importantly, we found several lines of evidence for “BRCAness” in a subset of tumors. These included mutations in genes that confer “BRCAness”, a mutational signature and an increase of small indels. Re-analysis of SNV calls from the TCGA KIRC-US cohort confirmed a high frequency of the “BRCAness” mutational signature AC3 in clear cell RCC. Our findings warrant further pre-clinical experiments and may lead to novel personalized therapies for RCC patients.
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Peng C, Gu L, Wang L, Huang Q, Wang B, Guo G, Fan Y, Gao Y, Ma X, Zhang X. Role of presurgical targeted molecular therapy in renal cell carcinoma with an inferior vena cava tumor thrombus. Onco Targets Ther 2018; 11:1997-2005. [PMID: 29670375 PMCID: PMC5898583 DOI: 10.2147/ott.s158114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose The clinical benefit of targeted molecular therapy (TMT) in renal cell carcinoma (RCC) with an inferior vena cava (IVC) tumor thrombus remains controversial. The aim of this study was to investigate the effects of presurgical TMT on the heights and levels of IVC thrombi, and to assess its impact on surgical strategy. Patients and methods We retrospectively reviewed data from 18 patients with RCC involving IVC tumor thrombi who were treated at our hospital with presurgical TMT followed by an IVC thrombectomy. The changes in heights and levels of the IVC thrombi were compared using computed tomography or magnetic resonance imaging. Clinicopathological factors were also evaluated to assess their association with TMT efficacy. Results The tumor thrombus levels before TMT were stage I in 1 patient (5.6%), II in 12 patients (66.7%), III in 4 patients (22.2%), and IV in 1 patient (5.6%). After a median of two treatment cycles (range: 1–3), the thrombus height decreased measurably in 11 patients (61.1%) with an average shrinkage of 17.7%. The thrombus height remained stable in five patients (27.8%) and was enlarged in two (11.1%). Downstaging of the thrombus level occurred in four patients (22.2%); the surgical strategy was modified in three patients (16.7%) to avoid cardiopulmonary bypass and complicated liver mobilization under robot-assisted laparoscopy. Furthermore, a higher neutrophil count tended to be associated with a worse clinical TMT-associated outcome (P=0.056). Conclusion Our data suggest a limited influence of presurgical TMT with a positive benefit in RCC patients with level III and IV thrombus. Thrombus-level regression may potentially alter the surgical strategy, especially robotic surgery. However, our findings require validation with additional prospective investigations.
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Affiliation(s)
- Cheng Peng
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Chinese PLA Medical Academy, Beijing, People's Republic of China
| | - Liangyou Gu
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Chinese PLA Medical Academy, Beijing, People's Republic of China
| | - Lei Wang
- Department of Urology, Chinese PLA 534 Hospital, Luoyang, People's Republic of China
| | - Qingbo Huang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Chinese PLA Medical Academy, Beijing, People's Republic of China
| | - Baojun Wang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Chinese PLA Medical Academy, Beijing, People's Republic of China
| | - Gang Guo
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Chinese PLA Medical Academy, Beijing, People's Republic of China
| | - Yang Fan
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Chinese PLA Medical Academy, Beijing, People's Republic of China
| | - Yu Gao
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Chinese PLA Medical Academy, Beijing, People's Republic of China
| | - Xin Ma
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Chinese PLA Medical Academy, Beijing, People's Republic of China
| | - Xu Zhang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Chinese PLA Medical Academy, Beijing, People's Republic of China
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González J, Gaynor JJ, Alameddine M, Esteban M, Ciancio G. Indications, complications, and outcomes following surgical management of locally advanced and metastatic renal cell carcinoma. Expert Rev Anticancer Ther 2018; 18:237-250. [PMID: 29353520 DOI: 10.1080/14737140.2018.1431530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Surgery may set the basis for a potential cure or would provide the best achievable quality of life in locally advanced or metastatic renal cell carcinoma (mRCC). However, survival extension with this approach would be scarce and not exempt from adverse events, thus preventing its recommendation in an already frail patient. An evidence based analysis on the role of surgery in each of the possible clinical scenarios involved under this heading may provide a clear picture on this issue and would be of value in the decision making process. Areas covered: Current literature was queried in PubMed/Medline in a systematic fashion. Manuscripts included were selected according to the quality of the data provided. A narrative review strategy was adopted to summarize the evidence acquired. Expert commentary: A surgery-based multimodal treatment approach should be strongly considered after adequate counseling in locally advanced and mRCC, since it may provide for additional benefits in terms of survival. However, a critical reevaluation of its adequacy, optimal timing, and selection of ideal candidates is currently ongoing.
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Affiliation(s)
- Javier González
- a Servicio de Urología , Hospital Central de la Cruz Roja San José y Santa Adela , Madrid , Spain
| | - Jeffrey J Gaynor
- b Department of Surgery (Division of Transplantation), Department of Urology and the Miami Transplant Institute , University of Miami Miller School of Medicine, Jackson Memorial Hospital , Miami , FL , USA
| | - Mahmoud Alameddine
- b Department of Surgery (Division of Transplantation), Department of Urology and the Miami Transplant Institute , University of Miami Miller School of Medicine, Jackson Memorial Hospital , Miami , FL , USA
| | - Manuel Esteban
- c Servicio de Urología , Hospital Nacional de Parapléjicos , Toledo , Spain
| | - Gaetano Ciancio
- b Department of Surgery (Division of Transplantation), Department of Urology and the Miami Transplant Institute , University of Miami Miller School of Medicine, Jackson Memorial Hospital , Miami , FL , USA
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Anesthesia for Nephrectomy with Vena Cava Thrombectomy. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Catalá-Ripoll JV, Mateo-Rodríguez E, Juez-López M, Martín-González I, Doménech-Pérez C, Martínez-León J, Carmona-García P, Genovés-Crespo M. Cirugía de tumores retroperitoneales con afectación de vena cava: revisión de 18 casos. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Tumor renal con extensión intracardiaca y trombosis masiva. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Hofer L, Gasch C, Hatiboglu G, Motsch J, Grüllich C, Duensing S, Hohenfellner M. [Level IV inferior vena cava tumor thrombus : A rare diagnosis in patients with renal cell carcinoma]. Urologe A 2017; 56:868-875. [PMID: 28349189 DOI: 10.1007/s00120-017-0369-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Renal cell carcinoma in combination with a supradiaphragmatic tumor thrombus is a rare tumor entity. Radical surgery including nephrectomy and thrombectomy is still considered standard treatment. The extent of the tumor thrombus should be preoperatively evaluated by MRI and TEE. An interdisciplinary team is important for surgery planning and realization. Despite the known risks of an operation, a longer overall survival is achieved.
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Affiliation(s)
- L Hofer
- Urologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - C Gasch
- Urologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - G Hatiboglu
- Urologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - J Motsch
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Grüllich
- Klinik für Medizinische Onkologie, Nationales Zentrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - S Duensing
- Urologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - M Hohenfellner
- Urologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
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Jiménez-Romero C, Conde M, de la Rosa F, Manrique A, Calvo J, Caso Ó, Muñoz C, Marcacuzco A, Justo I. Treatment of caval vein thrombosis associated with renal tumors. Cir Esp 2017; 95:152-159. [PMID: 28242025 DOI: 10.1016/j.ciresp.2017.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 01/11/2017] [Accepted: 01/19/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Renal carcinoma represents 3% of all solid tumors and is associated with renal or inferior caval vein (IVC) thrombosis between 2-10% of patients, extending to right atrial in 1% of cases. METHODS This is a retrospective study that comprises 5 patients who underwent nephrectomy and thrombectomy by laparotomy because of renal tumor with IVC thrombosis level iii. RESULTS Four patients were males and one was female, and the mean age was 57,2 years (range: 32-72). Most important clinical findings were hematuria, weight loss, weakness, anorexia, and pulmonary embolism. Diagnostic confirmation was performed by CT scanner. Metastatic disease was diagnosed before surgery in 3 patients. Suprahepatic caval vein and hepatic hilium (Pringle's maneouver) were clamped in 4 patients, and ligation of infrarrenal caval vein was carry out in one patient. Five patients developed mild complications (Clavien I/II). No patient died and the mean hospital stay was 8,6 days. All patients were treated with chemotherapy, and 3 died because distant metastasis, but 2 are alive, without recurrence, at 5 and 60 months, respectively. CONCLUSIONS Nephrectomy and thrombectomy in renal tumors with caval thrombosis can be curative in absence of metastasis or, at less, can increase survival or quality of live. Then these patients must be treated in liver transplant units because major surgical and anesthesiologic expertise. Adjuvant treatment with tyrosin kinase inhibitors must be validate in the future with wider experiences.
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Affiliation(s)
- Carlos Jiménez-Romero
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España.
| | - María Conde
- Servicio de Cirugía General, Hospital Universitario Lucus Augusti, Lugo, España
| | | | - Alejandro Manrique
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Jorge Calvo
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Óscar Caso
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Carlos Muñoz
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Alberto Marcacuzco
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - Iago Justo
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España
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Choi DK, Jeon HG, Jeong CW, Kwak C, Song C, Chung J, Hong SK, Hong SH, Seo SI. Surgical treatment of renal cell carcinoma: Can morphological features of inferior vena cava tumor thrombus on computed tomography or magnetic resonance imaging be a prognostic factor? Int J Urol 2017; 24:102-109. [DOI: 10.1111/iju.13272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 11/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Don Kyoung Choi
- Department of Urology; Hallym University Kangnam Sacred Heart Hospital; Hallym University School of Medicine; Seoul Korea
| | - Hwang Gyun Jeon
- Department of Urology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Chang Wook Jeong
- Department of Urology; Seoul National University Hospital; Seoul National University of Medicine; Seoul Korea
| | - Cheol Kwak
- Department of Urology; Seoul National University Hospital; Seoul National University of Medicine; Seoul Korea
| | - Cheryn Song
- Department of Urology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Jinsoo Chung
- Department of Urology; National Cancer Center; Goyang Korea
| | - Sung Kyu Hong
- Department of Urology; Seoul National University Bundang Hospital; Seongnam Korea
| | - Sung-Hoo Hong
- Department of Urology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Seong Il Seo
- Department of Urology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
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Mager R, Daneshmand S, Evans CP, Palou J, Martínez-Salamanca JI, Master VA, McKiernan JM, Libertino JA, Haferkamp A, Haferkamp A, Capitanio U, Carballido JA, Chantada V, Chromecki T, Ciancio G, Daneshmand S, Evans CP, Gontero P, González J, Hohenfellner M, Huang WC, Koppie TM, Libertino JA, Espinós EL, Lorentz A, Martínez-Salamanca JI, Master VA, McKiernan JM, Montorsi F, Novara G, O'Malley P, Pahernik S, Palou J, Moreno JLP, Pruthi RS, Faba OR, Russo P, Scherr DS, Shariat SF, Spahn M, Terrone C, Tilki D, Vázquez-Martul D, Donoso CV, Vergho D, Wallen EM, Zigeuner R. Renal cell carcinoma with inferior vena cava involvement: Prognostic effect of tumor thrombus consistency on cancer specific survival. J Surg Oncol 2016; 114:764-768. [PMID: 27562252 DOI: 10.1002/jso.24395] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/18/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Renal cell carcinoma forming a venous tumor thrombus (VTT) in the inferior vena cava (IVC) has a poor prognosis. Recent investigations have been focused on prognostic markers of survival. Thrombus consistency (TC) has been proposed to be of significant value but yet there are conflicting data. The aim of this study is to test the effect of IVC VTT consistency on cancer specific survival (CSS) in a multi-institutional cohort. METHODS The records of 413 patients collected by the International Renal Cell Carcinoma-Venous Thrombus Consortium were retrospectively analyzed. All patients underwent radical nephrectomy and tumor thrombectomy. Kaplan-Meier estimate and Cox regression analyses investigated the impact of TC on CSS in addition to established clinicopathological predictors. RESULTS VTT was solid in 225 patients and friable in 188 patients. Median CSS was 50 months in solid and 45 months in friable VTT. TC showed no significant association with metastatic spread, pT stage, perinephric fat invasion, and higher Fuhrman grade. Survival analysis and Cox regression rejected TC as prognostic marker for CSS. CONCLUSIONS In the largest cohort published so far, TC seems not to be independently associated with survival in RCC patients and should therefore not be included in risk stratification models. J. Surg. Oncol. 2016;114:764-768. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Rene Mager
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany.
| | | | | | - Joan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | - Juan I Martínez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - Viraj A Master
- Department of Urology, Emory University, Atlanta, Georgia
| | - James M McKiernan
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | | | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Umberto Capitanio
- Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy
| | - Joaquín A Carballido
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - Venancio Chantada
- Department of Urology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain
| | - Thomas Chromecki
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Gaetano Ciancio
- Miami Transplant Institute, University of Miami, Miami, Florida
| | | | | | - Paolo Gontero
- Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy
| | - Javier González
- Department of Urology, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain
| | | | - William C Huang
- Department of Urology, New York University School of Medicine, New York, New York
| | - Theresa M Koppie
- Department of Urology, Oregon Health and Science University, Portland, Oregon
| | | | | | - Adam Lorentz
- Department of Urology, Emory University, Atlanta, Georgia
| | - Juan I Martínez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - Viraj A Master
- Department of Urology, Emory University, Atlanta, Georgia
| | - James M McKiernan
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Francesco Montorsi
- Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy
| | - Giacomo Novara
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Padraic O'Malley
- Department of Urology, Weill Cornell Medical Center, New York, New York
| | - Sascha Pahernik
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | | | - Raj S Pruthi
- Department of Urology, UNC at Chapel Hill, Chapel Hill, North Carolina
| | | | - Paul Russo
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical Center, New York, New York
| | | | - Martin Spahn
- Department of Urology, University of Würzburg, Würzburg, Germany
| | - Carlo Terrone
- Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy
| | - Derya Tilki
- Department of Urology, UC Davis Medical Center, Sacramento, California
| | - Dario Vázquez-Martul
- Department of Urology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain
| | | | - Daniel Vergho
- Department of Urology, University of Würzburg, Würzburg, Germany
| | - Eric M Wallen
- Department of Urology, UNC at Chapel Hill, Chapel Hill, North Carolina
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria
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