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Filizzola R, Romero D, Mendez S, Brunstein D, Benitez A. Results of Radical Nephrectomy and Inferior Vena Cava Thrombectomy. Curr Urol Rep 2024; 25:339-342. [PMID: 39138814 DOI: 10.1007/s11934-024-01228-2] [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] [Accepted: 07/30/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE OF REVIEW Renal Cell Carcinoma (RCC) with invasion into the inferior vena cava (IVC) is a rare and mortal condition. Patients with RCC have an average life expectancy of no more than six months, thus requiring an aggressive surgical approach. We analyze the outcomes of patients that underwent surgery at a single medical institution. RECENT FINDINGS The analysis of recent series of successful treatment with radical nephrectomy and IVC thrombectomy shows a 5 year survival from 45 to 69%. We found in the analyzed series that the success of the treatment in these patients depends on the resection of the renal tumor and venous thrombectomy. We found that at our medical institution nephrectomy and IVC thrombectomy with primary repair have no intraoperative mortality and no pulmonary embolism. Nephrectomy and thrombectomy of IVC is a reliable approach for patients with advance RCC.
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Affiliation(s)
- Roberto Filizzola
- Department of Vascular Surgery, Hospital Central Instituto de Prevision Social, Asunción, 001519, Paraguay.
| | - Daniel Romero
- Department of Urology, Hospital Central Instituto de Previsión Social, Asunción, 001519, Paraguay
| | - Samuel Mendez
- Department of Urology, Hospital Central Instituto de Previsión Social, Asunción, 001519, Paraguay
| | - David Brunstein
- Department of Vascular Surgery, Hospital Central Instituto de Prevision Social, Asunción, 001519, Paraguay
| | - Alejandro Benitez
- Department of Vascular Surgery, Hospital Central Instituto de Prevision Social, Asunción, 001519, Paraguay
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Ademi B, Jaha L, Haxhiu I, Çuni X, Tahiri A, Gashi J, Koshi A, Jaha A. Surgical management of renal cell carcinoma with subhepatic inferior vena cava tumor thrombus: a case report and review of the literature. J Med Case Rep 2024; 18:201. [PMID: 38649941 PMCID: PMC11036609 DOI: 10.1186/s13256-024-04517-z] [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: 09/05/2023] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Renal cell carcinomas are the most common form of kidney cancer in adults. In addition to metastasizing in lungs, soft tissues, bones, and the liver, it also spreads locally. In 2-10% of patients, it causes a thrombus in the renal or inferior vena cava vein; in 1% of patients thrombus reaches the right atrium. Surgery is the only curative option, particularly for locally advanced disease. Despite the advancements in laparoscopic, robotic and endovascular techniques, for this group of patients, open surgery continues to be among the best options. CASE REPORT Here we present a case of successful tumor thrombectomy from the infrahepatic inferior vena cava combined with renal vein amputation and nephrectomy. Our patient, a 58 year old Albanian woman presented to the doctors office with flank pain, weight loss, fever, high blood pressure, night sweats, and malaise. After a comprehensive assessment, which included urine analysis, complete blood count, electrolytes, renal and hepatic function tests, as well as ultrasonography and computed tomography, she was diagnosed with left kidney renal cell carcinoma involving the left renal vein and subhepatic inferior vena cava. After obtaining informed consent from the patient we scheduled her for surgery, which went well and without complications. She was discharged one week after to continue treatment with radiotherapy, chemotherapy, and immunotherapy. CONCLUSION Open surgery is a safe and efficient way to treat renal cell carcinoma involving the renal vein and inferior vena cava. It is superior to other therapeutic modalities. When properly done it provides acceptable long time survival and good quality of life to patients.
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Affiliation(s)
- Bekim Ademi
- Department of Vascular Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Luan Jaha
- Department of Vascular Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo.
| | - Isa Haxhiu
- Department of Urology, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Xhevdet Çuni
- Department of Urology, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Afrim Tahiri
- Department of Abdominal Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Jetmir Gashi
- Department of Vascular Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Adhurim Koshi
- Department of Vascular Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Art Jaha
- Department of Vascular Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
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Taweemonkongsap T, Suk-Ouichai C, Jitpraphai S, Woranisarakul V, Hansomwong T, Chotikawanich E. Survival benefits after radical nephrectomy and IVC thrombectomy of renal cell carcinoma patients with inferior vena cava thrombus. Heliyon 2024; 10:e25835. [PMID: 38390094 PMCID: PMC10881333 DOI: 10.1016/j.heliyon.2024.e25835] [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: 08/21/2023] [Revised: 12/15/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Objective The role of tumor thrombus as a predictor of survival in patients with renal cell carcinoma (RCC) is controversial. This study aims to evaluate surgical and oncological outcomes after surgery in RCC with inferior vena cava (IVC) tumor thrombus patients. Materials and methods A total of 58 patients (2002-2019) underwent radical nephrectomy and IVC thrombectomy at our institute, were retrospectively reviewed. Kaplan-Meier analysis was utilized to compare survival benefits between cohorts and Cox-regression to evaluate potential predictors of patient survival. Results There were 5(8.6%), 21(36.2%), 23(39.7%) and 9 (15.5%) patients with tumor thrombus level I, II, III and IV respectively. The major complications (Clavien 3-5) were observed in 15 patients (25.8%) and 12 patients (80%) were patients with high thrombus level (III-IV). There was 9%mortality (5patients): 2 intraoperatively and 3 postoperatively. Median follow-up was 15 months (IQR:5-41). Two-year overall survival (OS) was 80% and 75% in all patients and pN0M0 cohort, respectively. There was significant difference in OS among each IVC thrombus level cohort (p < 0.02). Two-year OS of metastatic RCC patients was 67% and not significantly different when compared to non-metastatic cohort (p = 0.12). On multivariate analysis, only sarcomatoid dedifferentiation was associated with OS(p = 0.04). Disease-free survival was not significantly different among thrombus-level cohorts (p = 0.65). Conclusions Our study suggested that surgical treatment for RCC with IVC thrombus provided substantial OS outcomes. Although survival was significantly reduced with higher IVC thrombus level cohort, the level of thrombus itself was not an independent factor. Only sarcomatoid dedifferentiation was a predictor for reduced OS after radical nephrectomy and tumor thrombectomy. Meticulous patient selection and prompt counselling are substantial step for the operation.
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Affiliation(s)
- Tawatchai Taweemonkongsap
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalairat Suk-Ouichai
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Siros Jitpraphai
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varat Woranisarakul
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thitipat Hansomwong
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekkarin Chotikawanich
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Shah MS, Wang KR, Shah YB, Ragam R, Simhal RK, Ghodoussipour S, Djaladat H, Mark JR, Lallas CD, Chandrasekar T. A Narrative Review on Robotic Surgery as Treatment for Renal Cell Carcinoma with Inferior Vena Cava Thrombus. J Clin Med 2024; 13:1308. [PMID: 38592152 PMCID: PMC10932232 DOI: 10.3390/jcm13051308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Renal cell carcinoma (RCC) is a common diagnosis, of which a notable portion of patients present with an extension into the venous circulation causing an inferior vena cava (IVC) tumor thrombus. Venous extension has significant implications for staging and subsequent treatment planning, with recommendations for more aggressive surgical removal, although associated surgical morbidity and mortality is relatively increased. The methods for surgical removal of RCC with IVC thrombus remain complex, particularly surrounding the use of robot-assisted surgery. Robot assistance for radical nephrectomy in this context is recently emerging. Thrombus level has important implications for surgical technique and prognosis. Other preoperative considerations may include location, laterality, size, and wall invasion. The urology literature on treatment of such tumors is largely limited to case series and institutional studies that describe the feasibility of various surgical options for these complex tumors. Further understanding of the outcomes and patient-specific risk factors would shed increased light on the optimal treatment for such cases. This narrative review provides a thorough overview on the previously reported use of robot-assisted nephrectomy in RCC with IVC thrombus to inform further studies which may optimize outcomes and guide shared decision-making.
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Affiliation(s)
- Mihir S. Shah
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Kerith R. Wang
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Yash B. Shah
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Radhika Ragam
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | | | - Saum Ghodoussipour
- Division of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Houman Djaladat
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - James R. Mark
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Costas D. Lallas
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
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Rooseno G, Hakim L, Djojodimedjo T. A systematic review and meta-analysis on the efficacy of preoperative renal artery embolization prior to radical nephrectomy for renal cell carcinoma: Is it necessary? Arch Ital Urol Androl 2023; 95:12018. [PMID: 38058293 DOI: 10.4081/aiua.2023.12018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/02/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION Radical nephrectomy for Renal Cell Carcinoma (RCC) is still the treatment of choice for all stages except for stage I and IV, which need patient selectivity. The purpose of Renal Artery Embolization (RAE) pre-operative before radical nephrectomy is to facilitate resection, reduce bleeding, and reduce the time to surgery, but the necessity of this procedure is still debatable. This study investigates the efficacy of pre-operative Renal Artery Embolization (PRAE) before radical nephrectomy for RCC patients. METHODS The systematic searches based on PRISMA guidelines were conducted in Pubmed, Scopus, Web of Science, Medrxiv, and ScienceDirect databases with pre-defined keywords. Both analyses, quantitative and qualitative, were performed to assess blood loss, transfusion rate, surgical time, Intensive Care Unit (ICU) stay, and hospital stay. RESULTS A total of 921 patients from 8 eligible studies were included. The blood loss was significantly lower in the PRAE group compared to the control group (p = < 0.00001; SMD -20 mL; 95%CI -0.29, -0.12). There is no statistically significant difference between RAE and without RAE in the transfusion rate nephrectomy (p = 0.53, OR 0.65; 95% CI 0.16, 2.57), mean operative time (p = 0.69; SMD 5.91; 95% CI -23.25, 35.07), mean length of hospital stay (p = 0.05; SMD 0.56; 95% CI 0.00, 1.12), and mean length of stay in the ICU (p = 0.45; SMD 11.61; 95% CI -18.35, 41.57) Conclusions: PRAE before radical nephrectomy significantly reduces blood loss in RCC patients but is similar in the surgical time, transfusion rate, and length of hospital stay and ICU stay.
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Affiliation(s)
- Gullyawan Rooseno
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Lukman Hakim
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Tarmono Djojodimedjo
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
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Gwon JG, Cho YP, Han Y, Suh J, Min SK. Technical Tips for Performing Suprahepatic Vena Cava Tumor Thrombectomy in Renal Cell Carcinoma without Using Cardiopulmonary Bypass. Vasc Specialist Int 2023; 39:23. [PMID: 37667821 PMCID: PMC10480049 DOI: 10.5758/vsi.230056] [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: 06/21/2023] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023] Open
Abstract
Radical nephrectomy with tumor thrombectomy for advanced renal cell carcinoma is an oncologically relevant approach that can achieve long-term survival even in the presence of distant metastases. However, the surgical techniques pose significant challenges. The objective of this clinical review was to present technical recommendations for tumor thrombectomy in the vena cava to facilitate surgical treatment. Transesophageal echocardiography is required to prepare for this procedure. Cardiopulmonary bypass should be considered when the tumor thrombus has invaded the cardiac chamber and clamping is not feasible because of the inability to milk the intracardiac chamber thrombus in the caudal direction. Prior to performing a cavotomy, it is crucial to clamp the contralateral renal vein and infrarenal and suprahepatic inferior vena cava (IVC). If the suprahepatic IVC is separated from the surrounding tissue, it can be gently pulled down toward the patient's leg until the lower margin of the atrium becomes visible. Subsequently, the tumor thrombus should be carefully pulled downward to a position where it can be clamped. Implementing the Pringle maneuver to reduce blood flow from the hepatic veins to the IVC during IVC cavotomy is simpler than clamping the hepatic veins. Sequential clamping is a two-stage method of dividing thrombectomy by clamping the IVC twice, first suprahepatically and then midretrohepatically. This sequential clamping technique helps minimize hypotension status and the Pringle maneuver time compared to single clamping. Additionally, a spiral cavotomy can decrease the degree of primary closure narrowing. The oncological prognoses of patients can be improved by incorporating these technical recommendations.
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Affiliation(s)
- Jun Gyo Gwon
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Pil Cho
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Youngjin Han
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Jungyo Suh
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Division of Vascular Surgery, Department of Surgery, Seoul National University Hospital, Seoul, Korea
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Caño Velasco J, Polanco Pujol L, Herranz Amo F, González García J, Aragón Chamizo J, Hernández Fernández C. Utility of preoperative vascular embolization of renal tumors with left renal vein tumor thrombus. Actas Urol Esp 2021; 45:615-622. [PMID: 34764049 DOI: 10.1016/j.acuroe.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES Preoperative renal artery embolization (PRAE) for large renal masses may be performed prior to nephrectomy in order to simplify the procedure and reduce intraoperative bleeding. The objective of this work is to determine the role of PRAE on intraoperative bleeding and postoperative complications in left renal tumors with tumor thrombus limited to the left renal vein (level 0). MATERIAL AND METHODS Retrospective analysis to evaluate 46 patients who underwent left radical nephrectomy and thrombectomy for the treatment of renal cell carcinoma with level 0 tumor thrombus during the period 1990-2020. PRAE was limited to those cases in which surgical access to the main renal artery was presumed a priori difficult in the preoperative imaging study (n = 9; 19.6%). Intraoperative bleeding was estimated based on the perioperative transfusion rate, and postoperative complications were categorized according to the Clavien-Dindo classification. The Chi-squared test was used for comparisons. A multivariate analysis was performed to identify predictors of transfusion and complications. RESULTS There were no significant differences in the overall complication rate (11.1% vs. 32.4%, p = 0.19), major complication rate (0% vs. 8.1%, p = 0.51), or transfusion rate (11.1% vs. 19%, p = 0.49) between both groups (PRAE vs. non-PRAE). In the multivariate analysis, PRAE did not behave as a predictor of complications (OR: 0.11, 95%CI 0.01-2.86; p = 0.18) nor transfusion (OR: 0.46, 95%CI 0.02-7.38; p = 0.58). CONCLUSIONS In our study on left RCC with level 0 tumor thrombus and difficult access to the main renal artery, PRAE was not associated with increased bleeding or postoperative complications, and it did not behave as an independent predictor of these variables. Therefore, it could be used as a preoperative maneuver to facilitate vascular management in selected cases.
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Affiliation(s)
- J Caño Velasco
- Unidad de Tumores Renales con Afectación Venosa (TRAV), Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - L Polanco Pujol
- Unidad de Tumores Renales con Afectación Venosa (TRAV), Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F Herranz Amo
- Unidad de Tumores Renales con Afectación Venosa (TRAV), Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J González García
- Unidad de Tumores Renales con Afectación Venosa (TRAV), Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Aragón Chamizo
- Unidad de Tumores Renales con Afectación Venosa (TRAV), Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C Hernández Fernández
- Unidad de Tumores Renales con Afectación Venosa (TRAV), Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Liu B, Li F, Liu M, Xu Z, Gao B, Wang Y, Zhou H. Prognostic Roles of Phosphofructokinase Platelet in Clear Cell Renal Cell Carcinoma and Correlation with Immune Infiltration. Int J Gen Med 2021; 14:3645-3658. [PMID: 34321910 PMCID: PMC8312753 DOI: 10.2147/ijgm.s321337] [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: 05/22/2021] [Accepted: 07/08/2021] [Indexed: 12/24/2022] Open
Abstract
Background Abnormal expression of phosphofructokinase platelet (PFKP) has been reported in various cancer types. However, the role of PFKP in clear cell renal cell carcinoma (ccRCC) remains unclear. Methods In this study, the PFKP expression levels in various cancers were systemically described by integrating multiple kinds of publicly available databases. The relationship between PFKP expression and clinical prognosis of ccRCC patients was analyzed based on the TCGA database. Furthermore, PFKP-related genes and the top 10 hub genes were identified. The enrichment analysis, PPI network, and the relationship between PFKP and tumor-infiltrating immune cells were conducted to explore why PFKP was associated with clinical outcomes in ccRCC patients. Results PFKP was significantly highly expressed in kidney cancer, especially in ccRCC. Moreover, patients with low expression of PFKP were correlated with poor 5-year and 10-year overall survival (OS) (P < 0.05). Low PFKP expression was a risk factor associated with decreased OS in subgroups including males, females, grade 3–4, and stage III–IV (all P < 0.05). GO and KEGG enrichment analyses showed that 10 hub genes were mainly enriched in the tumor immune response. Finally, PFKP expression level was highly correlated with the infiltration of B cell, CD8+ T cell, CD4+ T cell, macrophage, neutrophil, and dendritic cell. Conclusion In short, our findings suggested that PFKP is highly expressed in ccRCC significantly and facilitated tumor immune response which in turn associated with a good prognosis.
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Affiliation(s)
- Bin Liu
- Department of Urology, the First Hospital of Jilin University, Changchun, 130021, Jilin, People's Republic of China
| | - Faping Li
- Department of Urology, the First Hospital of Jilin University, Changchun, 130021, Jilin, People's Republic of China
| | - Mingdi Liu
- Key Laboratory of Pathobiology, Ministry of Education, Jilin University, Changchun, 130021, Jilin, People's Republic of China
| | - Zhixiang Xu
- Key Laboratory of Pathobiology, Ministry of Education, Jilin University, Changchun, 130021, Jilin, People's Republic of China
| | - Baoshan Gao
- Department of Urology, the First Hospital of Jilin University, Changchun, 130021, Jilin, People's Republic of China
| | - Yishu Wang
- Key Laboratory of Pathobiology, Ministry of Education, Jilin University, Changchun, 130021, Jilin, People's Republic of China
| | - Honglan Zhou
- Department of Urology, the First Hospital of Jilin University, Changchun, 130021, Jilin, People's Republic of China
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Caño Velasco J, Polanco Pujol L, Herranz Amo F, González García J, Aragón Chamizo J, Hernández Fernández C. Utility of preoperative vascular embolization of renal tumors with left renal vein tumor thrombus. Actas Urol Esp 2021; 45:S0210-4806(21)00043-7. [PMID: 33958218 DOI: 10.1016/j.acuro.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/17/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Preoperative renal artery embolization (PRAE) for large renal masses may be performed prior to nephrectomy in order to simplify the procedure and reduce intraoperative bleeding. The objective of this work is to determine the role of PRAE on intraoperative bleeding and postoperative complications in left renal tumors with tumor thrombus limited to the left renal vein (level 0). MATERIAL AND METHODS Retrospective analysis to evaluate 46 patients who underwent left radical nephrectomy and thrombectomy for the treatment of renal cell carcinoma with level 0 tumor thrombus during the period 1990-2020. PRAE was limited to those cases in which surgical access to the main renal artery was presumed a priori difficult in the preoperative imaging study (n=9; 19.6%). Intraoperative bleeding was estimated based on the perioperative transfusion rate, and postoperative complications were categorized according to the Clavien-Dindo classification. The Chi-squared test was used for comparisons. A multivariate analysis was performed to identify predictors of transfusion and complications. RESULTS There were no significant differences in the overall complication rate (11.1% vs. 32.4%, P=.19), major complication rate (0% vs.8.1%, P=.51), or transfusion rate (11.1% vs. 19%, P=.49) between both groups (PRAE vs. non-PRAE). In the multivariate analysis, PRAE did not behave as a predictor of complications (OR:0.11, 95%CI 0.01-2.86; P=.18) nor transfusion (OR:0.46, 95%CI 0.02-7.38;P=.58). CONCLUSIONS In our study on left renal cell carcinomas with level 0 tumor thrombus and difficult access to the main renal artery, PRAE was not associated with increased bleeding or postoperative complications, and it did not behave as an independent predictor of these variables. Therefore, it could be used as a preoperative maneuver to facilitate vascular management in selected cases.
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Affiliation(s)
- J Caño Velasco
- Unidad de Tumores Renales con Afectación Venosa (TRAV), Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - L Polanco Pujol
- Unidad de Tumores Renales con Afectación Venosa (TRAV), Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F Herranz Amo
- Unidad de Tumores Renales con Afectación Venosa (TRAV), Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J González García
- Unidad de Tumores Renales con Afectación Venosa (TRAV), Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Aragón Chamizo
- Unidad de Tumores Renales con Afectación Venosa (TRAV), Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - C Hernández Fernández
- Unidad de Tumores Renales con Afectación Venosa (TRAV), Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Masic S, Smaldone MC. Robotic renal surgery for renal cell carcinoma with inferior vena cava thrombus. Transl Androl Urol 2021; 10:2195-2198. [PMID: 34159102 PMCID: PMC8185684 DOI: 10.21037/tau.2019.06.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Surgical management of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus is inherently complex, posing challenges for even the most experienced urologists. Until the mid-2000s, nephrectomy with IVC thrombectomy was exclusively performed using variations of the open technique initially described decades earlier, but since then several institutions have reported their robotic experiences. Robotic IVC thrombectomy was initially reported for level I and II thrombi, and more recently in higher-lever III thrombi. In general, the robotic approach is associated with less blood loss and shorter hospital stays compared to the open approach, low rates of open conversion in reported cases, relatively low rates of high-grade complications, and favorable overall survival on short-term follow-up in limited cohorts. Operative times are longer, costs are significantly higher, and left-sided tumors always require intraoperative repositioning and usually require preoperative embolization. To date, criteria for patient selection or open conversion have not been defined, and long-term oncologic outcomes are lacking. While the early published robotic experience demonstrates feasibility and safety in carefully selected patients, longer-term follow-up remains necessary. Patient selection, indications for open conversion, logistics of conversion particularly in emergent settings, necessity and safety of preoperative embolization, the value proposition, and long-term oncologic outcomes must all be clearly defined before this approach is widely adopted.
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Affiliation(s)
- Selma Masic
- Fox Chase Cancer Center, Philadelphia, PA, USA
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Seetharam Bhat KR, Moschovas MC, Onol FF, Rogers T, Roof S, Patel VR, Schatloff O. Robotic renal and adrenal oncologic surgery: A contemporary review. Asian J Urol 2021; 8:89-99. [PMID: 33569275 PMCID: PMC7859360 DOI: 10.1016/j.ajur.2020.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/30/2020] [Accepted: 04/22/2020] [Indexed: 01/20/2023] Open
Abstract
Robot-assisted surgery has evolved over time. Radical nephrectomy with inferior vena cava thrombectomy is feasible and safe for level I, II and III thrombus in high volume centers. Though it is feasible for level IV thrombus, this procedure needs a multi-departmental co-operation. However, the safety of robot-assisted procedures in this subset is still unknown. Robot-assisted partial nephrectomy has been universally approved and found oncologically safe. Robotic adrenalectomy has been increasingly utilized for select cases, especially in bilateral tumors and for retroperitoneal adrenalectomy.
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Affiliation(s)
| | | | - Fikret Fatih Onol
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Travis Rogers
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Shannon Roof
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Vipul R. Patel
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Oscar Schatloff
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
- Sudmedica Health, Chile
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12
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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: 7] [Impact Index Per Article: 1.8] [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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Ghoreifi A, Djaladat H. Surgical Tips for Inferior Vena Cava Thrombectomy. Curr Urol Rep 2020; 21:51. [PMID: 33090290 DOI: 10.1007/s11934-020-01007-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to describe the preoperative evaluation, surgical techniques, and postoperative management of patients with renal cell carcinoma (RCC) undergoing radical nephrectomy (RN) and inferior vena cava (IVC) thrombectomy. RECENT FINDINGS RN and IVC thrombectomy remains the standard management option in non-metastatic RCC patients with IVC thrombus. A comprehensive preoperative workup, including high-quality imaging, blood works, and appropriate consultations are required for all patients. The aim of the surgery is complete resection of all tumor burden, which requires a skillful surgical team for such a challenging procedure and is inherently associated with a high rate of perioperative morbidity and mortality. Preoperative CT or MRI is essential for surgical planning. The surgical approach is mainly determined by the level of the tumor thrombus. The open approach has been the standard, though minimally invasive and robotic techniques are emerging in selected cases by experienced surgeons.
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Affiliation(s)
- Alireza Ghoreifi
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave. Suite 7416, Los Angeles, CA, 90089, USA
| | - Hooman Djaladat
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave. Suite 7416, Los Angeles, CA, 90089, USA.
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14
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Immediate preoperative renal artery embolization in the resection of complex renal tumors (UroCCR-48 Reinbol study). Int Urol Nephrol 2020; 53:229-234. [PMID: 32880091 DOI: 10.1007/s11255-020-02628-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We evaluated the feasibility and outcomes of immediate preoperative renal artery embolization (IPRAE) before complex nephrectomy for locally advanced RCC ± inferior vena cava thrombus (IVCT). METHODS A comparative retrospective (2007-2017) multicenter study which included 145 patients with locally advanced RCC ± IVCT: 99 radical nephrectomies vs. 46 radical nephrectomies with IPRAE identified in the prospective UroCCR national database (CNIL DR 2013-206; NCT03293563). IPRAE was performed under local anesthesia the day of nephrectomy (< 4 h prior to nephrectomy). The primary endpoint was peroperative blood loss (mL). Secondary outcomes were: tolerance of embolization (pain visual scale), success rate of IPRAE defined by complete devascularization of the kidney, perioperative complications according to Clavien score and postoperative GFR. RESULTS The baseline characteristics of IPRAE and the control groups were similar. Tumor staging was 14% T2b, 41% T3a, 27% T3b, 13% T3c, 6% T4. The success rate of IPRAE was 98%. Median artery embolizated per patient was 2 (Agochukwu and Shuch in World J Urol 32:581-589, 2014; Marshall et al. in J Urol 139:1166-1172, 1988; Yap et al. in BJU Int 110:1283-1288, 2012;Gill et al. in J Urol. 194:929-938, 2015; Wang et al. in Eur Urol 69:1112-1119, 2016). No severe complications occurred after IPRAE. Postembolization syndrome was reported in 7% (Clavien I-II). Mean peroperative blood losses in the IPRAE and control groups were: 726 ± 118 ml and 1083 ± 114 ml (P = 0.03). In a multivariate analysis that included: age, Karnofsky index, IPRAE (yes vs. no), IVCT (yes vs. no), tumor size and synchronous metastasis, no IPRAE and IVCT were significantly associated with increased peroperative bleeding. CONCLUSION IPRAE before nephrectomy for locally advanced and/or IVCT tumors was well tolerated, was associated with lower peroperative bleeding and did not increase the incidence or severity of postoperative complications.
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Tang G, Chen X, Wang J, He W, Niu Z. Adjuvant instant preoperative renal artery embolization facilitates the radical nephrectomy and thrombectomy in locally advanced renal cancer with venous thrombus: a retrospective study of 54 cases. World J Surg Oncol 2020; 18:206. [PMID: 32795311 PMCID: PMC7427865 DOI: 10.1186/s12957-020-01985-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/31/2020] [Indexed: 01/31/2023] Open
Abstract
Background The role of renal artery embolization (RAE) in the therapeutic armamentarium is always controversial. The present study aimed to assess the safety and the surgical outcomes of the instant renal artery embolization (I-RAE) prior to nephrectomy and thrombectomy in patients with locally advanced renal cell carcinoma (RCC) with venous thrombus. Methods We performed a retrospective analysis of 54 patients treated with nephrectomy and thrombectomy between January 2012 and January 2019. Twenty-four patients were treated with I-RAE before surgery. Thirty patients received surgery alone (non-RAE group). The patient demographics, operation time, blood loss, transfusion requirements, complications, and other surgical parameters were analyzed between the two groups. Results The mean tumor size in the I-RAE group was significantly larger than that in the non-RAE group (11.1 cm versus 7.9 cm; p = .001). The mean estimated blood loss was significantly lower in the I-RAE group compared to that in the non-RAE group (596 ml versus 827 ml; p = .015), and the patients in the non-RAE group were more likely to receive blood transfusion (red blood cell, RBC units, 4 U versus 6 U, p = .025; plasma volume, 200 ml versus 400 ml, p = .01). No differences were found in operative duration, ICU stay, perioperative complications, and length of postoperative hospitalization. Conclusions Instant preoperative adjuvant renal artery embolization (I-RAE) is a safe technique. It facilitates nephrectomy and thrombectomy by reducing blood loss, transfusion requirements, and complications of delayed operations, providing urologists with a reliable option for treatment of locally advanced RCC with tumor thrombus.
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Affiliation(s)
- Guangxin Tang
- Shouguang People's Hospital, Weifang, Shandong, China
| | - Xiaoxu Chen
- Department of Pediatric Surgery, Jining First People's Hospital, Jining, Shandong, China.,Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jianwei Wang
- Department of Urology, Shandong Provincial ENT Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Wei He
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China. .,Department of Urology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
| | - Zhihong Niu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China. .,Department of Urology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
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16
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You D, Choi SY, Ryu J, Kim CS. Surgical Consideration in Renal Tumors. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Fan Y, Li H, Zhang X, Wang B, Liu K, Huang Q, Gao Y, Gu L, Ma X. Robotic Radical Nephrectomy and Thrombectomy for Left Renal Cell Carcinoma with Renal Vein Tumor Thrombus: Superior Mesenteric Artery as an Important Strategic Dividing Landmark. J Endourol 2019; 33:557-563. [PMID: 31106582 DOI: 10.1089/end.2019.0159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective: The aim of this study was to explore a new treatment strategy for left renal vein tumor thrombus directed at the thrombus level and the therapeutic effect of robotic surgery. Materials and Methods: Fifteen patients with left renal cell carcinoma with renal vein tumor thrombus (Mayo level 0) who underwent robotic radical nephrectomy and thrombectomy from July 2013 to July 2017 were included in this series. If the left renal vein thrombus transcended the superior mesenteric artery (SMA), the thrombus was classified as level 0b, the patient was positioned right side up for thrombectomy and repositioned left side up for nephrectomy, and angioembolization of left renal artery was necessary; otherwise, the thrombus was classified as level 0a and the patient was positioned left side up for both nephrectomy and thrombectomy. Baseline, perioperative, and follow-up data were analyzed. Results: Of all 15 patients, 10 had a level 0a tumor thrombus and 5 had a level 0b tumor thrombus. For level 0a patients, median operating time was 130 minutes, median estimated blood loss was 125 mL, with no patient receiving transfusion, and median hospital stay was 3.5 days. For level 0b patients, median operating time was 180 minutes, median estimated blood loss was 250 mL, with one patient receiving transfusion, and median hospital stay was 5 days. No perioperative complications or positive surgical margins occurred. For level 0a patients, one patient with preexisting lumbar vertebral metastasis died during a median follow-up of 39 months. For level 0b patients, all patients were alive at a median follow-up of 16.5 months. Conclusions: Our initial experience shows that the new treatment strategy for left renal vein tumor thrombus with the SMA as a dividing landmark directed at the thrombus level is safe and feasible. A larger cohort of level 0b patients and longer-term follow-up are needed to further assess the strategic advantages.
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Affiliation(s)
- Yang Fan
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army General Hospital, PLA Medical School, Beijing, People's Republic of China
| | - Hongzhao Li
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army General Hospital, PLA Medical School, Beijing, People's Republic of China
| | - Xu Zhang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army General Hospital, PLA Medical School, Beijing, People's Republic of China
| | - Baojun Wang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army General Hospital, PLA Medical School, Beijing, People's Republic of China
| | - Kan Liu
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army General Hospital, PLA Medical School, Beijing, People's Republic of China
| | - Qingbo Huang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army General Hospital, PLA Medical School, Beijing, People's Republic of China
| | - Yu Gao
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army General Hospital, PLA Medical School, Beijing, People's Republic of China
| | - Liangyou Gu
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army General Hospital, PLA Medical School, Beijing, People's Republic of China
| | - Xin Ma
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army General Hospital, PLA Medical School, Beijing, People's Republic of China
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Wang JH, Li MJ, Tang DX, Xu S, Mao JQ, Cai JB, He M, Shu Q, Lai C. Neoadjuvant transcatheter arterial chemoembolization and systemic chemotherapy for treatment of clear cell sarcoma of the kidney in children. J Pediatr Surg 2019; 54:550-556. [PMID: 30318310 DOI: 10.1016/j.jpedsurg.2018.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 08/27/2018] [Accepted: 09/24/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Clear cell sarcoma of the kidney (CCSK) is a rare and aggressive malignant renal tumor. We describe our experience with neoadjuvant transcatheter arterial chemoembolization (TACE) and systematic chemotherapy for the treatment of advanced CCSK in children. METHODS Between January 2010 and December 2016, seven patients (3 boys and 4 girls; median 2.2 years) with advanced CCSK received preoperative TACE of renal artery and systemic chemotherapy. The chemoembolic emulsion for TACE consisted of cisplatin, pirarubicin, vindesine, and iodized oil. Preoperative systemic chemotherapy with vindesine, ifosfamide, and etoposide was administered three weeks after TACE. Nephrectomy was performed three weeks after systemic chemotherapy. After surgery, patients received radiotherapy and postoperative chemotherapy. RESULTS No cardiotoxicity, renal insufficiency, or hepatic dysfunction was found in any patients. Grade II-III marrow suppression developed in four patients. One patient with tumor progress during neoadjuvant therapy failed to successfully undergo surgery and died. Six patients underwent nephrectomy after neoadjuvant therapy. Median follow-up period was 49.5 months (range, 11-83 months). Five patients have recurrence-free survival. One patient is still in postoperative chemotherapy after nephrectomy, radiotherapy and thoracoscopic resection of lung metastases. CONCLUSIONS Neoadjuvant TACE and systemic chemotherapy appeared to be feasible in the treatment of advanced CCSK in this pilot study. THE TYPE OF STUDY A case series with no comparison group. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jin-Hu Wang
- Division of Surgical Oncology, Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, 310052 Hangzhou, China.
| | - Min-Ju Li
- Division of Surgical Oncology, Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, 310052 Hangzhou, China.
| | - Da-Xing Tang
- Division of pediatric urology, Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, 310052 Hangzhou, China.
| | - Shan Xu
- Division of pediatric urology, Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, 310052 Hangzhou, China.
| | - Jun-Qing Mao
- Division of Surgical Oncology, Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, 310052 Hangzhou, China.
| | - Jia-Bin Cai
- Division of Surgical Oncology, Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, 310052 Hangzhou, China.
| | - Min He
- Division of Surgical Oncology, Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, 310052 Hangzhou, China.
| | - Qiang Shu
- Division of Surgical Oncology, Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, 310052 Hangzhou, China.
| | - Can Lai
- Department of Radiology, The Children's Hospital, Zhejiang University School of Medicine, No. 3333 Binsheng Road, 310052 Hangzhou, China.
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Tohi Y, Makita N, Suzuki I, Suzuki R, Kubota M, Sugino Y, Inoue K, Kawakita M. En bloc laparoscopic radical nephrectomy with inferior vena cava thrombectomy: A single-institution experience. Int J Urol 2018; 26:363-368. [PMID: 30508876 DOI: 10.1111/iju.13873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 11/04/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the outcomes of laparoscopic radical nephrectomy with inferior vena cava thrombectomy for right renal cell carcinoma at Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan. METHOD A retrospective review of the clinical records of five patients who underwent laparoscopic radical nephrectomy with inferior vena cava thrombectomy for right renal cell carcinoma between 2013 and 2017 was carried out. The surgical procedure included ligation and cutting of the right renal artery, followed by kidney mobilization. The left renal vein, and the caudal and cephalad sides of the inferior vena cava thrombus were clamped using laparoscopic vascular clamps, and the inferior vena cava was incised. The free kidney and tumor thrombus were placed en bloc in a retrieval bag. Subsequently, the inferior vena cava was laparoscopically closed using a continuous suture. RESULTS The median operative time, pneumoperitoneum time, blood loss and postoperative hospital stay were 316 min, 266 min, 400 mL and 7 days, respectively. The median clamp time was 28 min (range 13-105 min). One patient (20%) required a perioperative blood transfusion. The surgical margin was negative in all patients. Only one patient experienced a major complication (Clavien-Dindo grade ≥3), namely a postoperative hemorrhage requiring transarterial embolism. CONCLUSION En bloc laparoscopic radical nephrectomy with inferior vena cava thrombectomy is a challenging yet feasible procedure for experienced surgeons in carefully selected patients. Further studies of this surgical procedure are required for standardization and safe application.
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Affiliation(s)
- Yoichiro Tohi
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Noriyuki Makita
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Issei Suzuki
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Ryosuke Suzuki
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Masashi Kubota
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yoshio Sugino
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Koji Inoue
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Mutsushi Kawakita
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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Shao Y, Liu Z, Liu J, Wang H, Huang L, Lin T, Liu J, Wei Q, Zeng H, He G, Li X. Expression and epigenetic regulatory mechanism of BNIP3 in clear cell renal cell carcinoma. Int J Oncol 2018; 54:348-360. [PMID: 30365137 PMCID: PMC6254932 DOI: 10.3892/ijo.2018.4603] [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: 04/02/2018] [Accepted: 10/02/2018] [Indexed: 02/05/2023] Open
Abstract
The majority of clear cell renal cell carcinomas (ccRCCs) are caused by an accumulation of hypoxia-inducible factor (HIF) and the overexpression of downstream genes in response to the von Hippel-Lindau (VHL) gene becoming inactivated. In the present study, our hypothesis was that BNIP3, a gene positioned downstream of HIF, would be expressed at a higher level in ccRCC; however, instead, lower levels of BNIP3 expression were identified in RCC tumor tissues compared with adjacent non-tumor tissues. These changes were associated with lower levels of VHL, and higher levels of HIF and vascular endothelial growth factor. BNIP3 was also undetectable in three investigated RCC cell lines (786-O, ACHN, A498) and GRC-1-1 cells. Methylation of the BNIP3 promoter was not detected, and neither did treatment with a methylation inhibitor cause cell proliferation. However, treatment with a histone deacetylation inhibitor, trichostatin A (TSA), inhibited cultured RCC cell proliferation, promoted apoptosis and restored BNIP3 expression. Furthermore, histone deacetylation of the BNIP3 promoter was identified in ACHN and 786-O cells, and the acetylation status was restored following TSA treatment. Taken together, the results of the present study suggest that histone deacetylation, but not methylation, is most likely to cause BNIP3 inactivation in RCC. The data also indicated that restoration of BNIP3 expression by a histone deacetylation inhibitor led to growth inhibition and apoptotic promotion in RCC.
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Affiliation(s)
- Yanxiang Shao
- Department of Urology, Institute of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Zhenhua Liu
- Department of Urology, Institute of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jianbang Liu
- Department of Urology, Institute of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Haizhou Wang
- Department of Urology, Institute of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Long Huang
- Department of Urology, Institute of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Tianhai Lin
- Department of Urology, Institute of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jiyan Liu
- Department of Oncology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Gu He
- State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiang Li
- Department of Urology, Institute of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Robotic Inferior Vena Cava Thrombectomy: Are We Entering the House Through an Attic Window? Eur Urol Focus 2018; 4:641-642. [DOI: 10.1016/j.euf.2018.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/10/2018] [Accepted: 10/23/2018] [Indexed: 11/18/2022]
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22
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Gunn AJ, Patel AR, Rais-Bahrami S. Role of Angio-Embolization for Renal Cell Carcinoma. Curr Urol Rep 2018; 19:76. [DOI: 10.1007/s11934-018-0827-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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23
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Crisan N, Andras I, Grad DL, Telecan T, Coman RT, de Cobelli O, Matei DV, Coman I. Dual Combined Laparoscopic Approach for Renal-Cell Carcinoma with Renal Vein and Level I-II Inferior Vena Cava Thrombus: Our Technique and Initial Results. J Endourol 2018; 32:837-842. [PMID: 29947249 DOI: 10.1089/end.2018.0228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To present our technique and initial results of dual combined retroperitoneal and transperitoneal laparoscopic approach for the treatment of renal-cell carcinoma (RCC) with level 0-II venous tumor thrombus. PATIENTS AND METHODS We included nine consecutive patients with RCC and level 0-II inferior vena cava (IVC) thrombus who underwent laparoscopic radical nephrectomy and IVC thrombectomy using dual combined laparoscopic approach in our department between January 2016 and June 2017. RESULTS The mean operative time was 150 minutes when cavotomy was not performed and 240 minutes when cavotomy with thrombectomy was required. The mean IVC clamping time was 24 minutes and the mean blood loss was 300 mL. We encountered no major intraoperative or postoperative complications (Clavien III-IV). The patients were discharged a mean of 7 days after the procedure. At the 6-month follow-up, all patients were alive. One patient presented a retroperitoneal enlarged lymph node and started systemic treatment. CONCLUSIONS The dual combined laparoscopic approach for kidney tumors with level 0-II IVC thrombus is feasible, reproducible, and especially useful in patients with complex renal pedicle. The technique provides early arterial control by retroperitoneal approach, which reduces the blood flow through the renal vein and has the advantage of minimal mobilization of the thrombus-bearing renal vein; it therefore lowers the risk of tumor embolism and intraoperative hemorrhage.
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Affiliation(s)
- Nicolae Crisan
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania .,2 Urology Department, Clinical Municipal Hospital , Cluj-Napoca, Romania
| | - Iulia Andras
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania .,2 Urology Department, Clinical Municipal Hospital , Cluj-Napoca, Romania
| | - Doru-Lucian Grad
- 2 Urology Department, Clinical Municipal Hospital , Cluj-Napoca, Romania
| | - Teodora Telecan
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Radu-Tudor Coman
- 3 Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | | | - Deliu Victor Matei
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania .,4 Urology Division, European Institute of Oncology , Milan, Italy
| | - Ioan Coman
- 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania .,2 Urology Department, Clinical Municipal Hospital , Cluj-Napoca, Romania
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Zhu P, Du S, Chen S, Zheng S, Hu Y, Liu L, Zheng S. The role of deep hypothermic circulatory arrest in surgery for renal or adrenal tumor with vena cava thrombus: a single-institution experience. J Cardiothorac Surg 2018; 13:85. [PMID: 29976214 PMCID: PMC6034231 DOI: 10.1186/s13019-018-0772-z] [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] [Received: 02/21/2018] [Accepted: 06/22/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to review our experience in managing renal or adrenal tumors with level III or IV inferior vena cava thrombus by using deep hypothermic circulatory arrest (DHCA), and to evaluate survival outcomes. METHODS Between September 2004 and March 2016, we treated 33 patients with renal or adrenal malignancy tumor and thrombus extending into the inferior vena cava. Patients were identified according to radiographic records and operative findings. Clinicopathological and operative characteristics were recorded, and comparisons of clinical and operative characteristics through DHCA were performed. A Cox regression model was used to determine predictors of perioperative mortality. RESULTS Twenty-one out of 33 patients with level III (n = 15), level IV (n = 5), or level II (n = 1) renal or adrenal tumors were treated surgically through cardiopulmonary bypass (CPB) with DHCA, and 12 patients with level II or III tumors were treated surgically through normothermic CPB. Three complications were observed, and one death occurred perioperatively, owing to multiple organ failure. The overall perioperative mortality was 4.7%. There were significant differences in the clinicopathological characteristics, operative duration, estimated blood loss, transfusions and hospital stay depending on use of DHCA. Multivariate analysis indicated that the operative duration (OR, 3.78; P < 0.001), estimated blood loss (OR, 1.08; P = 0.02), and transfusion (OR, 2.13; P = 0.038) during/after surgery were positively associated with higher mortality and morbidity. DHCA failed to reach statistical significance (P = 0.378). CONCLUSIONS Use of CPB and DHCA to treat renal or adrenal tumors allows for complete tumor resection, especially at the T4 stage. Although it can cause physical damage, this technique does not increase operative risk and is a relatively safe approach.
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Affiliation(s)
- Peng Zhu
- Department of Cardiovascular Surgery, NanFang hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, People's Republic of China
| | - Songlin Du
- Department of Cardiovascular Surgery, NanFang hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, People's Republic of China
| | - Shijun Chen
- Department of Urinary Surgery, NanFang hospital, Southern Medical University, GuangZhou, People's Republic of China
| | - Shaobin Zheng
- Department of Urinary Surgery, NanFang hospital, Southern Medical University, GuangZhou, People's Republic of China
| | - Yu Hu
- Department of Cardiovascular Surgery, NanFang hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, People's Republic of China
| | - Li Liu
- Department of Cardiovascular Surgery, NanFang hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, People's Republic of China
| | - Shaoyi Zheng
- Department of Cardiovascular Surgery, NanFang hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, People's Republic of China.
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Sommer CM, Vollherbst DF, Richter GM, Kauczor HU, Pereira PL. [What can/should be treated in kidney tumors and when]. Radiologe 2017; 57:80-89. [PMID: 28130580 DOI: 10.1007/s00117-016-0202-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] [Indexed: 10/20/2022]
Abstract
CLINICAL/METHODICAL ISSUE In the treatment of localized renal cell carcinoma, the lack of randomization in controlled trials on thermal ablation is a major limitation. The latter leads to significant study bias and it ultimately remains unclear whether the improved overall survival in favor of partial nephrectomy can actually be attributed to the treatment method. STANDARD RADIOLOGICAL METHODS For T1a (≤4 cm) renal cell carcinoma without lymph node and distant metastases, excellent technical and clinical results have been described after imaging-guided radiofrequency ablation and cryoablation. METHODICAL INNOVATIONS Low major complication rates, preservation of renal function and three-dimensional confirmation of negative ablation margins (A0 ablation) are the advantages of computed tomography (CT)-guided thermal ablation. PERFORMANCE According to the results of controlled (non-randomized) trials on T1a renal cell cancer, the cancer-specific survival rates are comparable between ablative and surgical techniques. ACHIEVEMENTS It is high time for prospective randomized controlled trials to define the actual value of percutaneous thermal ablation and partial nephrectomy in the treatment of T1a renal cell carcinoma. PRACTICAL RECOMMENDATIONS Apart from localized renal cell carcinoma, angiomyolipoma and oncocytoma can be treated by thermal ablation. Transarterial embolization extends the radiological spectrum for the treatment of renal tumors, either as complementary embolization (e. g. before thermal ablation of T1a and T1b renal cell carcinoma), prophylactic embolization (e. g. angiomyolipoma >6 cm), preoperative embolization (e. g. before laparoscopic partial nephrectomy) or palliative embolization (e. g. in patients with symptomatic macrohematuria due to renal cell carcinoma).
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Affiliation(s)
- C M Sommer
- Klinik für Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. .,Klinik für Diagnostische und Interventionelle Radiologie, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Deutschland.
| | - D F Vollherbst
- Abteilung Neuroradiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - G M Richter
- Klinik für Diagnostische und Interventionelle Radiologie, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Deutschland
| | - H U Kauczor
- Klinik für Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - P L Pereira
- Klinik für Radiologie, minimal-invasive Therapien und Nuklearmedizin, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
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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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27
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Rodríguez-Cabello MA, Laso-García I, Donis-Canet F, Gómez-Dos-Santos V, Varona-Crespo C, Burgos-Revilla FJ. Renal cell carcinoma with vascular invasion: Mortality and prognostic factors. Actas Urol Esp 2017; 41:132-138. [PMID: 27461850 DOI: 10.1016/j.acuro.2016.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/05/2016] [Accepted: 06/06/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Analysis of the results of patients who had been operated of renal cell carcinoma with vascular invasion in our institution, evaluation of prognostic factors and complications. METHODS Retrospective observational study of 37 patients diagnosed of renal cell carcinoma with vascular invasion operated between May 1999 and July 2013. We used the method of Kaplan-Meier survival analysis and the Mantel-Haenszel's test (log rank) and the Cox's proportional hazards analysis test to analyse the risk factors of mortality. RESULTS The median age was 60 years. Mean follow-up period was 42.1 months. The median overall survival and disease-free survival were 53.8and 36.3 months, respectively. There was statistical association between overall survival and ASA (p=0.047), tumor stage (p=0.003), lymph node involvement (p=0.024), presence of metastases (p=0.013), level of tumor thrombus (p=0, 05) and histological type (p=0.001). 14 patients had grade IIIb complications or higher according to the Clavien Dindo classification, the most frequent was bleeding. CONCLUSIONS Renal cell carcinoma with vascular invasion is a disease with high rate of mortality. Surgery is a therapeutic option that can be curative. The number of complications is important. Survival is conditioned by the ASA, tumor stage, the level of tumor thrombus, lymph node involvement, metastasis and histological type.
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Affiliation(s)
| | - I Laso-García
- Servicios de Urología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - F Donis-Canet
- Servicios de Urología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - V Gómez-Dos-Santos
- Servicios de Urología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - C Varona-Crespo
- Servicios de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - F J Burgos-Revilla
- Servicios de Urología, Hospital Universitario Ramón y Cajal, Madrid, España
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Spelde A, Steinberg T, Patel PA, Garcia H, Kukafka JD, MacKay E, Gutsche JT, Frogel J, Fabbro M, Raiten JM, Augoustides JGT. Successful Team-Based Management of Renal Cell Carcinoma With Caval Extension of Tumor Thrombus Above the Diaphragm. J Cardiothorac Vasc Anesth 2017; 31:1883-1893. [PMID: 28502456 DOI: 10.1053/j.jvca.2017.02.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Audrey Spelde
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Toby Steinberg
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Harry Garcia
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jeremy D Kukafka
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jonathan Frogel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael Fabbro
- Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Jessie M Raiten
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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30
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Robot-assisted Level II-III Inferior Vena Cava Tumor Thrombectomy: Step-by-Step Technique and 1-Year Outcomes. Eur Urol 2016; 72:267-274. [PMID: 27663048 DOI: 10.1016/j.eururo.2016.08.066] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/30/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Level II-III inferior vena cava (IVC) tumor thrombectomy for renal cell carcinoma is among the most challenging urologic oncologic surgeries. In 2015, we reported the initial series of robot-assisted level III caval thrombectomy. OBJECTIVE To describe our University of Southern California technique in a step-by-step fashion for robot-assisted IVC level II-III tumor thrombectomy. DESIGN, SETTING, AND PARTICIPANTS Twenty-five selected patients with renal neoplasm and level II-III IVC tumor thrombus underwent robot-assisted surgery with a minimum 1-yr follow-up (July 2011 to March 2015). SURGICAL PROCEDURE Our standardized anatomic-based "IVC-first, kidney-last" technique for robot-assisted IVC thrombectomy focuses on minimizing the chances of an intraoperative tumor thromboembolism and major hemorrhage. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Baseline demographics, pathology data, 90-d and 1-yr complications, and oncologic outcomes at last follow-up were assessed. RESULTS AND LIMITATIONS Robot-assisted IVC thrombectomy was successful in 24 patients (96%) (level III: n=11; level II: n=13); one patient was electively converted to open surgery for failure to progress. Median data included operative time of 4.5h, estimated blood loss was 240ml, hospital stay 4 d; five patients (21%) received intraoperative blood transfusion. All surgical margins were negative. Complications occurred in four patients (17%): two were Clavien 2, one was Clavien 3a, and one was Clavien 3b. All patients were alive at a 16-mo median follow-up (range: 12-39 mo). CONCLUSIONS Robotic IVC tumor thrombectomy is feasible for level II-III thrombi. To maximize intraoperative safety and chances of success, a thorough understanding of applied anatomy and altered vascular collateral flow channels, careful patient selection, meticulous cross-sectional imaging, and a highly experienced robotic team are essential. PATIENT SUMMARY We present the detailed operative steps of a new minimally invasive robot-assisted surgical approach to treat patients with advanced kidney cancer. This type of surgery can be performed safely with low blood loss and excellent outcomes. Even patients with advanced kidney cancer could now benefit from robotic surgery with a quicker recovery.
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31
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Gaudino M, Lau C, Cammertoni F, Vargiu V, Gambardella I, Massetti M, Girardi LN. Surgical Treatment of Renal Cell Carcinoma With Cavoatrial Involvement: A Systematic Review of the Literature. Ann Thorac Surg 2016; 101:1213-21. [DOI: 10.1016/j.athoracsur.2015.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/08/2015] [Accepted: 10/01/2015] [Indexed: 01/17/2023]
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Lardas M, Stewart F, Scrimgeour D, Hofmann F, Marconi L, Dabestani S, Bex A, Volpe A, Canfield SE, Staehler M, Hora M, Powles T, Merseburger AS, Kuczyk MA, Bensalah K, Mulders PFA, Ljungberg B, Lam TBL. Systematic Review of Surgical Management of Nonmetastatic Renal Cell Carcinoma with Vena Caval Thrombus. Eur Urol 2015; 70:265-80. [PMID: 26707869 DOI: 10.1016/j.eururo.2015.11.034] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 11/30/2015] [Indexed: 11/29/2022]
Abstract
CONTEXT Overall, 4-10% of patients with renal cell carcinoma (RCC) present with venous tumour thrombus. It is uncertain which surgical technique is best for these patients. Appraisal of outcomes with differing techniques would guide practice. OBJECTIVE To systematically review relevant literature comparing the outcomes of different surgical therapies and approaches in treating vena caval thrombus (VCT) from nonmetastatic RCC. EVIDENCE ACQUISITION Relevant databases (Medline, Embase, and the Cochrane Library) were searched to identify relevant comparative studies. Risk of bias and confounding assessments were performed. A narrative synthesis of the evidence was presented. EVIDENCE SYNTHESIS The literature search identified 824 articles. Fourteen studies reporting on 2262 patients were included. No distinct surgical method was superior for the excision of VCT, although the method appeared to be dependent on tumour thrombus level. Minimal access techniques appeared to have better perioperative and recovery outcomes than traditional median sternotomy, but the impact on oncologic outcomes is unknown. Preoperative renal artery embolisation did not offer any oncologic benefits and instead resulted in significantly worse perioperative and recovery outcomes, including possibly higher perioperative mortality. The comparison of cardiopulmonary bypass versus no cardiopulmonary bypass showed no differences in oncologic outcomes. Overall, there were high risks of bias and confounding. CONCLUSIONS The evidence base, although derived from retrospective case series and complemented by expert opinion, suggests that patients with nonmetastatic RCC and VCT and acceptable performance status should be considered for surgical intervention. Despite a robust review, the findings were associated with uncertainty due to the poor quality of primary studies available. The most efficacious surgical technique remains unclear. PATIENT SUMMARY We examined the literature on the benefits of surgery to remove kidney cancers that have spread to neighbouring veins. The results suggest such surgery, although challenging and associated with high risk of complications, appears to be feasible and effective and should be contemplated for suitable patients if possible; however, many uncertainties remain due to the poor quality of the data.
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Affiliation(s)
- Michael Lardas
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Fiona Stewart
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | | | - Fabian Hofmann
- Department of Urology, Sunderby Hospital, Sunderby, Sweden
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Saeed Dabestani
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Alessandro Volpe
- Division of Urology, Maggiore della Carita' Hospital, University of Eastern Piedmont, Novara, Italy
| | - Steven E Canfield
- Division of Urology, University of Texas Medical School at Houston, Houston, TX, USA
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Milan Hora
- Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Thomas Powles
- The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Peter F A Mulders
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Thomas B L Lam
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK; Academic Urology Unit, University of Aberdeen, Aberdeen, UK.
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Wang M, Zhang J, Niu Y, Xing N. Feasibility of Pure Conventional Retroperitoneal Laparoscopic Radical Nephrectomy With Level II Vena Caval Tumor Thrombectomy. Urology 2015; 90:101-4. [PMID: 26723181 DOI: 10.1016/j.urology.2015.10.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 09/29/2015] [Accepted: 10/05/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report our surgical outcomes and experiences with pure conventional retroperitoneal laparoscopic nephrectomy and tumor thrombectomy for patients with right renal tumors and level II inferior vena caval tumor thrombus. MATERIALS AND METHODS From February 2012 to June 2014, five patients underwent pure conventional retroperitoneal laparoscopic nephrectomy and tumor thrombectomy. After the inferior vena cava was blocked using tourniquet loops above and below the thrombus with the contralateral renal vein being clamped, the inferior vena cava was opened, and the tumor thrombus was fully extracted. RESULTS The mean patient age was 57 years (43-71 years) and the mean body mass index was 22.44 kg/m(2) (20-25 kg/m(2)). The mean operative time was 241 minutes (180-300 minutes) and the mean estimated blood loss was 290 ml (50-1000 mL). The mean tumor size was 6.9 cm (3.5-9 cm) and the mean tumor thrombus length was 5.5 cm (4-10 cm). One patient needed an intraoperative transfusion, and the patient encountered bilateral lower limb deep vein thrombus. With a mean follow-up of 11.5 months (5-30 months), one patient was identified with lung metastasis 4 months postoperatively. CONCLUSION Although pure conventional laparoscopic nephrectomy and tumor thrombectomy for level II tumor thrombus are challenging, they are feasible in carefully selected patients. More studies are needed to confirm their superiority and oncologic outcomes.
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Affiliation(s)
- Mingshuai Wang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Junhui Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yinong Niu
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Nianzeng Xing
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Guo J, Ma J, Sun Y, Qin S, Ye D, Zhou F, He Z, Sheng X, Bi F, Cao D, Chen Y, Huang Y, Liang H, Liang J, Liu J, Liu W, Pan Y, Shu Y, Song X, Wang W, Wang X, Wu X, Xie X, Yao X, Yu S, Zhang Y, Zhou A. Chinese guidelines on the management of renal cell carcinoma (2015 edition). ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:279. [PMID: 26697439 PMCID: PMC4671863 DOI: 10.3978/j.issn.2305-5839.2015.11.21] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 11/04/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Jun Guo
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Jianhui Ma
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Yan Sun
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Shukui Qin
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Dingwei Ye
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Fangjian Zhou
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Zhisong He
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Xinan Sheng
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Feng Bi
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Dengfeng Cao
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Yingxia Chen
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Yiran Huang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Houjie Liang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Jun Liang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Jiwei Liu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Wenchao Liu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Yueyin Pan
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Yongqian Shu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Xin Song
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Weibo Wang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Xiuwen Wang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Xiaoan Wu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Xiaodong Xie
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Xin Yao
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Shiying Yu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Yanqiao Zhang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
| | - Aiping Zhou
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China ; 3 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 4 Cancer Hospital Affiliated to Fudan University, Shanghai 200032, China ; 5 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 6 Peking University Institute of Urology & Peking University First Hospital, Beijing 100034, China ; 7 West China Hospital of Sichuan University, Chengdu 610041, China ; 8 Washington University School of Medicine, St. Louis, USA ; 9 Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China ; 10 Southwest Hospital, Third Military Medical University, Chongqing 400038, China ; 11 Peking University International Hospital, Beijing 100142, China ; 12 The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 13 Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China ; 14 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 15 Jiangsu Province Hospital & First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 16 Yunnan Provincial Cancer Hospital, Kunming 650118, China ; 17 Shandong Provincial Hospital, Jinan 250012, China ; 18 Qilu Hospital of Shandong University, Jinan, China ; 19 PLA 174 Hospital & Nanjing Military Region Cancer Center, Xiamen 361003, China ; 20 General Hospital of Shenyang Military Command, Shenyang 110016, China ; 21 Cancer Hospital Affiliated to Tianjin Medical University, Tianjin 300060, China ; 22 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 23 Cancer Hospital Affiliated to Harbin Medical University, Harbin 150001, China
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Gill IS, Metcalfe C, Abreu A, Duddalwar V, Chopra S, Cunningham M, Thangathurai D, Ukimura O, Satkunasivam R, Hung A, Papalia R, Aron M, Desai M, Gallucci M. Robotic Level III Inferior Vena Cava Tumor Thrombectomy: Initial Series. J Urol 2015; 194:929-38. [PMID: 25858419 PMCID: PMC9083507 DOI: 10.1016/j.juro.2015.03.119] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE Level III inferior vena cava tumor thrombectomy for renal cancer is one of the most challenging open urologic oncology surgeries. We present the initial series of completely intracorporeal robotic level III inferior vena cava tumor thrombectomy. MATERIALS AND METHODS Nine patients underwent robotic level III inferior vena cava thrombectomy and 7 patients underwent level II thrombectomy. The entire operation (high intrahepatic inferior vena cava control, caval exclusion, tumor thrombectomy, inferior vena cava repair, radical nephrectomy, retroperitoneal lymphadenectomy) was performed exclusively robotically. To minimize the chances of intraoperative inferior vena cava thrombus embolization, an "inferior vena cava-first, kidney-last" robotic technique was developed. Data were accrued prospectively. RESULTS All 16 robotic procedures were successful, without open conversion or mortality. For level III cases (9), median primary kidney (right 6, left 3) cancer size was 8.5 cm (range 5.3 to 10.8) and inferior vena cava thrombus length was 5.7 cm (range 4 to 7). Median operative time was 4.9 hours (range 4.5 to 6.3), estimated blood loss was 375 cc (range 200 to 7,000) and hospital stay was 4.5 days. All surgical margins were negative. There were no intraoperative complications and 1 postoperative complication (Clavien 3b). At a median 7 months of followup (range 1 to 18) all patients are alive. Compared to level II thrombi the level III cohort trended toward greater inferior vena cava thrombus length (3.3 vs 5.7 cm), operative time (4.5 vs 4.9 hours) and blood loss (290 vs 375 cc). CONCLUSIONS With appropriate patient selection, surgical planning and robotic experience, completely intracorporeal robotic level III inferior vena cava thrombectomy is feasible and can be performed efficiently. Larger experience, longer followup and comparison with open surgery are needed to confirm these initial outcomes.
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Affiliation(s)
- Inderbir S Gill
- USC Institute of Urology, Departments of Urology, Radiology, Anesthesia & Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Regena Elena Cancer Center, Rome, Italy.
| | - Charles Metcalfe
- USC Institute of Urology, Departments of Urology, Radiology, Anesthesia & Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Regena Elena Cancer Center, Rome, Italy
| | - Andre Abreu
- USC Institute of Urology, Departments of Urology, Radiology, Anesthesia & Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Regena Elena Cancer Center, Rome, Italy
| | - Vinay Duddalwar
- USC Institute of Urology, Departments of Urology, Radiology, Anesthesia & Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Regena Elena Cancer Center, Rome, Italy
| | - Sameer Chopra
- USC Institute of Urology, Departments of Urology, Radiology, Anesthesia & Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Regena Elena Cancer Center, Rome, Italy
| | - Mark Cunningham
- USC Institute of Urology, Departments of Urology, Radiology, Anesthesia & Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Regena Elena Cancer Center, Rome, Italy
| | - Duraiyah Thangathurai
- USC Institute of Urology, Departments of Urology, Radiology, Anesthesia & Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Regena Elena Cancer Center, Rome, Italy
| | - Osamu Ukimura
- USC Institute of Urology, Departments of Urology, Radiology, Anesthesia & Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Regena Elena Cancer Center, Rome, Italy
| | - Raj Satkunasivam
- USC Institute of Urology, Departments of Urology, Radiology, Anesthesia & Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Regena Elena Cancer Center, Rome, Italy
| | - Andrew Hung
- USC Institute of Urology, Departments of Urology, Radiology, Anesthesia & Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Regena Elena Cancer Center, Rome, Italy
| | - Rocco Papalia
- USC Institute of Urology, Departments of Urology, Radiology, Anesthesia & Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Regena Elena Cancer Center, Rome, Italy
| | - Monish Aron
- USC Institute of Urology, Departments of Urology, Radiology, Anesthesia & Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Regena Elena Cancer Center, Rome, Italy
| | - Mihir Desai
- USC Institute of Urology, Departments of Urology, Radiology, Anesthesia & Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Regena Elena Cancer Center, Rome, Italy
| | - Michele Gallucci
- USC Institute of Urology, Departments of Urology, Radiology, Anesthesia & Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Regena Elena Cancer Center, Rome, Italy
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Haddad AQ, Leibovich BC, Abel EJ, Luo JH, Krabbe LM, Thompson RH, Heckman JE, Merrill MM, Gayed BA, Sagalowsky AI, Boorjian SA, Wood CG, Margulis V. Preoperative multivariable prognostic models for prediction of survival and major complications following surgical resection of renal cell carcinoma with suprahepatic caval tumor thrombus. Urol Oncol 2015; 33:388.e1-9. [PMID: 26004163 DOI: 10.1016/j.urolonc.2015.04.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 03/24/2015] [Accepted: 04/19/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Surgical resection for renal cell carcinoma (RCC) with suprahepatic inferior vena cava tumor thrombus is associated with significant morbidity, yet there are currently no tools for preoperative prognostic evaluation. Our goal was to develop a preoperative multivariable model for prediction of survival and risk of major complications in patients with suprahepatic thrombi. METHODS We identified patients who underwent surgery for RCC with suprahepatic tumor thrombus extension from 2000 to 2013 at 4 tertiary centers. A Cox proportional hazard model was used for analysis of overall survival (OS) and logistic regression was used for major complications within 90 days of surgery (Clavien ≥ 3A). Nomograms were internally calibrated by bootstrap resampling method. RESULTS A total of 49 patients with level III thrombus and 83 patients with level IV thrombus were identified. During median follow-up of 24.5 months, 80 patients (60.6%) died and 46 patients (34.8%) experienced major complication. Independent prognostic factors for OS included distant metastases at presentation (hazard ratio = 2.52, P = 0.002) and Eastern Cooperative Oncology Group (ECOG) performance status (hazard ratio = 1.84, P<0.0001). Variables associated with increased risk of major complications on univariate analysis included preoperative systemic symptoms, level IV thrombus, and elevated preoperative alkaline phosphatase and aspartate transaminase levels; however, only systemic symptoms (odds ratio = 8.45, P<0.0001) was an independent prognostic factor. Preoperative nomograms achieved a concordance index of 0.72 for OS and 0.83 for major complications. CONCLUSIONS We have developed and internally validated multivariable preoperative models for the prediction of survival and major complications in patients with RCC who have a suprahepatic inferior vena cava thrombus. If externally validated, these tools may aid in patient selection for surgical intervention.
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Affiliation(s)
- Ahmed Q Haddad
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Bradley C Leibovich
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN
| | - Edwin Jason Abel
- Department of Urology, University of Wisconsin School of Medicine, Madison WI
| | - Jun-Hang Luo
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Laura-Maria Krabbe
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX; University of Muenster Medical Center, Muenster, Germany
| | | | - Jennifer E Heckman
- Department of Urology, University of Wisconsin School of Medicine, Madison WI
| | - Megan M Merrill
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Bishoy A Gayed
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Arthur I Sagalowsky
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Stephen A Boorjian
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN
| | - Christopher G Wood
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Vitaly Margulis
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX.
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Chen YH, Wu XR, Hu ZL, Wang WJ, Jiang C, Kong W, Chen W, Xue W, Liu DM, Huang YR. Treatment of renal cell carcinoma with a level III or level IV inferior vena cava thrombus using cardiopulmonary bypass and deep hypothermic circulatory arrest. World J Surg Oncol 2015; 13:159. [PMID: 25897659 PMCID: PMC4411871 DOI: 10.1186/s12957-015-0584-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the minimally invasive cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) approach in the management of renal cell carcinoma (RCC) with level III or IV inferior vena cava (IVC) thrombus and evaluate the survival outcomes. METHODS We performed a retrospective analysis on 32 RCC patients with IVC thrombus that underwent nephrectomy and thrombectomy via the minimally invasive CPB/DHCA approach between January 2007 and December 2013. Perioperative variables (for example, operative time, CPB duration, and circulatory arrest duration), estimated blood loss, hospital stay, perioperative complications, and survival data were recorded and analyzed. RESULTS Thirty-two patients (median age: 56 years) were treated surgically using the CPB and DHCA approach for RCC with a level III (n=25) or level IV (n=7) tumor thrombus. The median operation time was 360 min (interquartile range (IQR): 300 to 435 min) with median CPB and DHCA durations of 149 min and 23 min, respectively. The median estimated blood loss was 2,500 ml. Four complications were observed but no deaths occurred perioperatively. The median follow-up was 25 months (range: 4 to 64 months). The mean overall survival (OS) was 28.2±4.6 months while the disease-free survival (DFS) was 19.5±11.6 months. In patients with M0 disease, ten patients developed metastases and were treated with sorafenib as an adjuvant therapy. The mean OS and DFS of this subgroup were 25.4±12.8 months and 16.0±14.2 months, respectively. CONCLUSIONS Radical nephrectomy and thrombectomy using CPB and DHCA to treat RCC is a relatively safe approach associated with low morbidity and mortality. This minimally invasive procedure may help minimize surgical trauma and improve perioperative outcomes.
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Affiliation(s)
- Yong-Hui Chen
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China.
| | - Xiao-Rong Wu
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China.
| | - Zhen-Lei Hu
- Department of Cardiovascular Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China.
| | - Wei-Jun Wang
- Department of Cardiovascular Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China.
| | - Chen Jiang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China.
| | - Wen Kong
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China.
| | - Wei Chen
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China.
| | - Wei Xue
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China.
| | - Dong-Ming Liu
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China.
| | - Yi-Ran Huang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China.
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Minocha J, Parvinian A, Bui JT, Knuttinen MG, Ray CE, Gaba RC. Transcatheter renal interventions: a review of established and emerging procedures. J Clin Imaging Sci 2015; 5:5. [PMID: 25806140 PMCID: PMC4322382 DOI: 10.4103/2156-7514.150448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/04/2015] [Indexed: 11/04/2022] Open
Abstract
Catheter-based interventions play an important role in the multidisciplinary management of renal pathology. The array of procedures available to interventional radiologists (IRs) includes established techniques such as angioplasty, stenting, embolization, thrombolysis, and thrombectomy for treatment of renovascular disease, as well as embolization of renal neoplasms and emerging therapies such as transcatheter renal artery sympathectomy for treatment of resistant hypertension. Here, we present an overview of these minimally invasive therapies, with an emphasis on interventional technique and clinical outcomes of the procedure.
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Affiliation(s)
- Jeet Minocha
- Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
| | - Ahmad Parvinian
- Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
| | - James T Bui
- Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
| | - Martha Grace Knuttinen
- Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
| | - Charles E Ray
- Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
| | - Ron C Gaba
- Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
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Abstract
Owing to improvements in catheters and embolic agents, renal artery embolization (RAE) is increasingly used to treat nephrological and urological disease. RAE has become a useful adjunct to medical resuscitation in severe penetrating, iatrogenic or blunt renal traumatisms with active bleeding, and might avoid surgical intervention, particularly among patients that are haemodynamically stable. The role of RAE in pre-operative or palliative management of advanced malignant renal tumours remains debated; however, RAE is recommended as a first-line therapy for bleeding angiomyolipomas and can be used as a preventative treatment for angiomyolipomas at risk of bleeding. RAE represents an alternative to nephrectomy in various medical conditions, including severe uncontrolled hypertension among patients with end-stage renal disease, renal graft intolerance syndrome or autosomal dominant polycystic kidney disease. RAE is increasingly used to treat renal artery aneurysms or symptomatic renal arteriovenous malformations, with a low complication rate as compared with surgical alternatives. This Review highlights the potential use of RAE as an adjunct in the management of renal disease. We first compare and contrast the technical approaches of RAE associated with the various available embolization agents and then discuss the complications associated with RAE and alternative procedures.
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Westesson KE, Klink JC, Rabets JC, Fergany AF, Klein EA, Stephenson AJ, Rini BI, Navia J, Krishnamurthi V. Surgical Outcomes After Cytoreductive Nephrectomy With Inferior Vena Cava Thrombectomy. Urology 2014; 84:1414-9. [DOI: 10.1016/j.urology.2014.05.078] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 04/04/2014] [Accepted: 05/02/2014] [Indexed: 11/28/2022]
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González J, Ciancio G. Caval Thrombus in Conjunction with Renal Tumors: Indication for Surgery and Technical Details. Curr Urol Rep 2014; 15:451. [DOI: 10.1007/s11934-014-0451-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Armstrong PA, Back MR, Shames ML, Bailey CJ, Kim T, Lawindy SM, Sexton WJ, Spiess PE. Outcomes after inferior vena cava thrombectomy and reconstruction for advanced renal cell carcinoma with tumor thrombus. J Vasc Surg Venous Lymphat Disord 2014; 2:368-76. [PMID: 26993539 DOI: 10.1016/j.jvsv.2014.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 05/06/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND This report details the experience of a multidisciplinary surgical team in the management of stage III and stage IV renal cell carcinoma (RCC) with concomitant inferior vena cava (IVC) tumor thrombus. METHODS A retrospective inquiry of our vascular database from 2003 to 2012 identified 55 surgical cases of stage III (n = 40) and stage IV (n = 15) RCC presenting with IVC tumor thrombus. Tumor characteristics and IVC tumor thrombus were evaluated by clinical staging and postoperative pathology staging. Patient demographics and surgical reconstruction are detailed. Cancer-specific outcomes consisted of oncologic surveillance with computed tomography or magnetic resonance imaging. A Clavien-Dindo classification of early (<30 days) complications and mortality was recorded, including a review of secondary surgical interventions. RESULTS According to the Novick classification of IVC tumor thrombus, there were 10 supradiaphragmatic (level IV), 20 intrahepatic (level III), and 25 infrahepatic (level II or I) tumor thrombi. Vena cava reconstruction was completed in 54 patients (98%), with one patient deemed unresectable. Vena cava control required cardiac bypass (n = 10), venovenous bypass (n = 4), or infrahepatic IVC control (n = 40). Reconstruction of the IVC was completed with two prosthetic interposition grafts for one stage IV thrombus and one stage III thrombus; two patch repairs were done for stage III thrombus, and there were 50 primary IVC repairs. All other IVC reconstructions were patent at a mean follow-up of 23 months. A single asymptomatic patient with primary IVC repair had estimated 30% IVC narrowing but no other measurable stenosis as detected by postoperative imaging. Three patients required reoperation (two for surgical site bleeding, one for small bowel fistula). Early surgical complications included Clavien-Dindo grades I (n = 3), II (n = 6), IIIa (n = 2), IIIb (n = 3), and V (n = 2). Regional retroperitoneal or distant recurrent RCC occurred in 26 patients (48%); a single patient demonstrating recurrent IVC tumor thrombus at 8 months required secondary IVC thrombectomy. All patients with tumor invasion of the IVC wall developed recurrent RCC, and no patient survived beyond 5 years. Early mortality was 3.6% (n = 2), with 27 patients (49%) dying within 24 months, resulting in an overall mortality for the cohort of 80% (n = 44) as established on routine regular postoperative surveillance. CONCLUSIONS A multidisciplinary approach for the management of advanced RCC and IVC tumor thrombus helps optimize outcomes. Primary IVC repairs are possible in most patients, and IVC patency is good. Recurrent tumor thrombus rates are low; however, RCC tumor recurrence and mortality are high, especially among patients with advanced cancer with IVC wall invasion.
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Affiliation(s)
- Paul A Armstrong
- Division of Vascular and Endovascular Surgery, University of South Florida, Tampa, Fla.
| | - Martin R Back
- Division of Vascular and Endovascular Surgery, University of South Florida, Tampa, Fla
| | - Murray L Shames
- Division of Vascular and Endovascular Surgery, University of South Florida, Tampa, Fla
| | - Charles J Bailey
- Division of Vascular and Endovascular Surgery, University of South Florida, Tampa, Fla
| | - Timothy Kim
- Department of Urology, University of South Florida, Tampa, Fla
| | | | - Wade J Sexton
- Department of Urology, University of South Florida, Tampa, Fla; Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Fla
| | - Philippe E Spiess
- Department of Urology, University of South Florida, Tampa, Fla; Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Fla
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44
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Patil MB, Montez J, Loh-Doyle J, Cai J, Skinner EC, Schuckman A, Thangathurai D, Skinner DG, Daneshmand S. Level III-IV Inferior Vena Caval Thrombectomy Without Cardiopulmonary Bypass: Long-Term Experience with Intrapericardial Control. J Urol 2014; 192:682-8. [DOI: 10.1016/j.juro.2014.03.112] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Mukul B. Patil
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jeremy Montez
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jeffrey Loh-Doyle
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jie Cai
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Eila C. Skinner
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Anne Schuckman
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Duraiyah Thangathurai
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Donald G. Skinner
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Siamak Daneshmand
- Center for Comprehensive Urologic Oncology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
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45
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Abstract
Interventional oncology, a term commonly used to indicate the minimally invasive procedures performed by interventional radiologists to diagnose and manage cancer, encompasses a broad spectrum of techniques unique to interventional radiology that have been established as a vital part of the multidisciplinary oncologic cancer care team. This article provides an updated overview of the variety of applications of image-guided procedures to distinct clinical scenarios, such as the diagnosis, treatment, and management of complications of malignancies.
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Affiliation(s)
- Bruno C Odisio
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Unit 1471, Houston, TX 77030, USA.
| | - Michael J Wallace
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Unit 1471, Houston, TX 77030, USA
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46
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Calero A, Armstrong PA. Renal cell carcinoma accompanied by venous invasion and inferior vena cava thrombus: classification and operative strategies for the vascular surgeon. Semin Vasc Surg 2014; 26:219-25. [PMID: 25220330 DOI: 10.1053/j.semvascsurg.2014.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Venous invasion is a common characteristic of renal cell carcinoma, manifesting as tumor thrombus with possible extension into the renal vein and, in extensive cases, the thrombus can reach from the renal vein to the right atrium. Currently, cytoreductive nephrectomy and tumor thrombectomy are the foundations for improving quality of life and survival in the treatment of renal cell carcinoma, and a role has emerged for a vascular specialist to become an integral part of operative planning and therapy.
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Affiliation(s)
- Aurelia Calero
- Division of Vascular and Endovascular Surgery, University of South Florida, USF Health Building 7th Floor, 2 Tampa General Circle, Tampa, FL 33606
| | - Paul A Armstrong
- Division of Vascular and Endovascular Surgery, University of South Florida, USF Health Building 7th Floor, 2 Tampa General Circle, Tampa, FL 33606.
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47
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Abstract
Renal arterial embolization (RAE) performed for the treatment of renal masses has been proven to be a safe and effective technique, with several decades of experience. RAE is well tolerated with few complications, particularly if the time interval from embolization to surgery is reduced to less than 48 hours. Review of the literature suggests that RAE is also extremely effective for palliation of symptoms in the setting of nonoperative advanced stage renal cell carcinoma. In addition, this technique plays a large role in the management of angiomyolipomas that are symptomatic or at risk of spontaneous rupture. To date, RAE has not been evaluated in a randomized controlled setting, which has contributed to its underutilization. All of these potential benefits warrant the need for prospective studies for further validation.
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Affiliation(s)
- David Li
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Bradley B Pua
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
| | - David C Madoff
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
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48
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Agochukwu N, Shuch B. Clinical management of renal cell carcinoma with venous tumor thrombus. World J Urol 2014; 32:581-9. [PMID: 24752606 DOI: 10.1007/s00345-014-1276-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 03/06/2014] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Venous invasion is common in advanced renal cell carcinoma (RCC) due to the unique biology of this cancer. The presence of a tumor thrombus often makes clinical management challenging. In this review, we detail specific preoperative, perioperative, and surgical strategies involving the care of the complex kidney cancer patient with venous tumor involvement. METHODS We performed a comprehensive review of selected peer-reviewed publications regarding RCC tumor thrombus biology, medical and surgical management techniques, and immediate and long-term outcomes. RESULTS The perioperative management may require special imaging techniques, preoperative testing, very recent imaging, and consultation with other surgical services. There are various approaches to these patients as the clinical presentation, stage of disease, primary tumor size, level of thrombus, degree of venous occlusion, presence of bland thrombus, and primary tumor laterality influence management. Select patients with metastatic disease can do well with cytoreductive nephrectomy and thrombectomy. Those with localized disease have a high risk of recurrence; however, some patients can exhibit durable survival with surgery alone. The evolving surgical and medical treatments are discussed. CONCLUSIONS Even when these surgeries are performed in high volume centers, significant perioperative complications are common and greater complications are seen with higher thrombus extent. If surgery is attempted, it is important for urologic oncologists to follow strict attention to specific surgical principles. These general principles include complete vascular control, avoidance of thrombus embolization, close hemodynamic monitoring, and institutional resources for caval resection/replacement and venous bypass if necessary.
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Affiliation(s)
- Nnenaya Agochukwu
- Department of Urology, Yale School of Medicine, 310 Cedar Street 238A, New Haven, CT, 06510, USA
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49
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Haddad AQ, Wood CG, Abel EJ, Krabbe LM, Darwish OM, Thompson RH, Heckman JE, Merril MM, Gayed BA, Sagalowsky AI, Boorjian SA, Margulis V, Leibovich BC. Oncologic outcomes following surgical resection of renal cell carcinoma with inferior vena caval thrombus extending above the hepatic veins: a contemporary multicenter cohort. J Urol 2014; 192:1050-6. [PMID: 24704115 DOI: 10.1016/j.juro.2014.03.111] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Suprahepatic inferior vena caval tumor thrombus in renal cell carcinoma cases has historically portended a poor prognosis. With advances in perioperative treatment of patients with high level thrombus contemporary outcomes are hypothesized to be improved. We evaluated long-term oncologic outcomes of contemporary surgical treatment of patients with renal cell carcinoma in whom level III-IV inferior vena caval thrombus was managed at high volume centers. MATERIALS AND METHODS We examined clinical and pathological data on patients with renal cell carcinoma and level III-IV thrombus treated with surgery from January 2000 to June 2013 at 4 tertiary referral centers. Survival outcomes and associated prognostic variables were assessed by Kaplan-Meier and multivariate Cox regression analyses. RESULTS We identified 166 patients, including 69 with level III and 97 with level IV thrombus. Median postoperative followup was 27.8 months. Patients with no evidence of nodal or distant metastasis (pN0/X, M0) had 5-year 49.0% cancer specific survival and 42.2% overall survival. There was no difference in survival based on tumor thrombus level or pathological tumor stage. Variables associated with an increased risk of death from kidney cancer on multivariate analysis were regional nodal metastases (HR 3.94, p <0.0001), systemic metastases (HR 2.39, p = 0.01), tumor grade 4 (HR 2.25, p = 0.02), histological tissue necrosis (HR 3.11, p = 0.004) and increased preoperative serum alkaline phosphatase (HR 2.30, p = 0.006). CONCLUSIONS Contemporary surgical management achieves almost 50% 5-year survival in patients without metastasis who have renal cell carcinoma thrombus above the hepatic veins. Factors associated with increased mortality included nodal/distant metastases, advanced grade, histological necrosis and increased preoperative serum alkaline phosphatase. These findings support an aggressive surgical approach to the treatment of patients with renal cell carcinoma who have advanced tumor thrombus.
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Affiliation(s)
- Ahmed Q Haddad
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher G Wood
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - E Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Laura-Maria Krabbe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Oussama M Darwish
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - R Houston Thompson
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota
| | - Jennifer E Heckman
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Megan M Merril
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Bishoy A Gayed
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Arthur I Sagalowsky
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stephen A Boorjian
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Bradley C Leibovich
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota
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50
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Zargar H, Addison B, McCall J, Bartlett A, Buckley B, Rice M. Renal artery embolization prior to nephrectomy for locally advanced renal cell carcinoma. ANZ J Surg 2014; 84:564-7. [DOI: 10.1111/ans.12545] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Homayoun Zargar
- Glickman Urological & Kidney Institute; Cleveland Clinic; Cleveland Ohio USA
| | - Ben Addison
- Department of Urology; Auckland City Hospital; Auckland New Zealand
| | - John McCall
- Dunedin School of Medicine; University of Otago; Dunedin New Zealand
| | - Adam Bartlett
- Hepatobiliary Unit; Department of General Surgery; Auckland City Hospital; Auckland New Zealand
| | - Brendan Buckley
- Department of Radiology; Auckland City Hospital; Auckland New Zealand
| | - Michael Rice
- Department of Urology; Auckland City Hospital; Auckland New Zealand
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