PUTH Grading System for Urinary Tumor With Supradiaphragmatic Tumor Thrombus: Different Surgical Techniques for
Zhuo Liu1, Yuxuan Li1, Yu Zhang1
1Department of Urology, Peking University Third Hospital, Beijing, China.
Insights
This study introduces the Peking University Third Hospital (PUTH) grading system for urinary tumors with supradiaphragmatic thrombus. The PUTH system guides tailored surgical strategies, demonstrating feasibility and effectiveness in managing complex cases.
Area of Science:
- Urology
- Surgical Oncology
- Cardiovascular Surgery
Background:
- Urinary tumors with supradiaphragmatic inferior vena cava (IVC) thrombus present significant treatment challenges.
- Mayo grade IV thrombus, extending into the supradiaphragmatic IVC, requires specialized surgical approaches.
- Existing classification systems may not fully capture the nuances of these complex tumor thrombus extensions.
Purpose of the Study:
- To explore and evaluate different treatment strategies for urinary tumors involving Mayo IV thrombus.
- To introduce and validate the Peking University Third Hospital (PUTH) grading system for supradiaphragmatic tumor thrombus.
- To correlate PUTH grading with surgical techniques and patient outcomes.
Main Methods:
- Retrospective analysis of 26 patients with Mayo IV thrombus treated at Peking University Third Hospital (January 2014 - April 2021).
- Classification of tumor thrombus using the PUTH grading system (PUTH-A and PUTH-B) based on thrombus location and extent.
- Description of surgical techniques employed, including open approaches with and without cardiopulmonary bypass, based on PUTH classification.
Main Results:
- 19 patients (PUTH-A) were treated with open surgery without cardiopulmonary bypass; 7 patients (PUTH-B) underwent open thoracotomy with cardiopulmonary bypass.
- No intraoperative deaths were recorded.
- At a median follow-up of 56 months, the overall mortality rate was 46.2%. Estimated 3-year overall survival was 52.4%.
Conclusions:
- The PUTH grading system effectively classifies urinary tumors with supradiaphragmatic thrombus.
- Tailored surgical techniques based on PUTH classification are feasible and associated with patient outcomes.
- The PUTH system offers a practical framework for managing complex urinary tumor thrombus cases.
Purpose:
To explore the different treatment strategies for urinary tumors with Mayo IV thrombus.
Materials And Methods:
We retrospectively analyzed the patients with Mayo IV thrombus in Peking University Third Hospital from January 2014 to April 2021. We used the Peking University Third Hospital (PUTH) grading system to classify urinary tumors with supradiaphragmatic thrombus. PUTH-A referred to the filled thrombus whose tip just reached above the diaphragm, or the thrombus entering the right atrium (< 2cm). PUTH-B referred to the filled thrombus entering the right atrium (> 2cm), or the thrombus invading the wall of the inferior pericardial vena cava. Detailed techniques were described for various scenarios. Clinicopathological data and perioperative outcomes were reported. Group difference statistical analysis was performed.
Results:
A total of 26 cases of urinary tumors with supradiaphragmatic IVC thrombus (Mayo grade IV) underwent treatment were enrolled in this study. 19 patients in the PUTH-A group received the open approach without sternotomy and cardiopulmonary bypass. Seven patients in the PUTH-B group received open thoracotomy assisted by cardiopulmonary bypass. No intraoperative death occurred. After 56 months of follow-up, 46.2% (12 of 26) patients died of all causes. Estimated 1-year, 2-year, and 3-year overall survival were 72.0% (95% CI, 54.4%-89.6%), 58.2% (95% CI, 38.0%-78.4%), and 52.4% (95% CI, 31.2%-73.6%), respectively.
Conclusions:
We introduced the PUTH grading system for the characteristics of urinary tumors with supradiaphragmatic tumor thrombus, and selected different surgical techniques according to different classifications. This grading system was relatively feasible and effective.
