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Surgical approaches to venous tumor thrombus
M L Quek1, J P Stein, D G Skinner
1University of Southern California, Norris Comprehensive Cancer Center, Department of Urology, Los Angeles 90033, USA.
Seminars in Urologic Oncology
|May 17, 2001
Summary
Renal cell carcinoma with tumor thrombus extension into the vena cava is challenging but manageable. Aggressive surgical approaches offer long-term survival for selected patients with isolated venous tumor thrombus.
Area of Science:
- Urology
- Surgical Oncology
- Nephrology
Background:
- Renal cell carcinoma (RCC) with tumor thrombus extending into the vena cava presents significant surgical challenges.
- Effective management requires meticulous surgical technique and comprehensive perioperative care.
Purpose of the Study:
- To evaluate the outcomes of surgical management for renal cell carcinoma with vena cava tumor thrombus extension.
- To identify prognostic factors influencing long-term survival in these patients.
Main Methods:
- Retrospective review of 99 patients with renal cell carcinoma and venous tumor extension.
- Classification of tumor thrombus extension into renal vein only, infrahepatic vena cava, intrahepatic vena cava, and intra-atrial.
- Analysis of overall survival rates at 2 and 5 years.
Main Results:
- Overall 2- and 5-year survival rates were 54% and 33%, respectively.
- Tumor thrombus level significantly correlated with overall survival.
- Patients with isolated venous tumor thrombus extension demonstrated encouraging survival rates.
Conclusions:
- An aggressive, optimistic surgical approach is warranted for selected patients with clinically confined tumors and isolated venous tumor thrombus extension.
- Careful surgical planning and perioperative management are crucial for achieving long-term survival.