IMMEDIATE AND LONG-TERM RESULTS OF NEPHRECTOMY WITH INFERIOR VENA CAVA THROMBECTOMY IN RENAL CELL CARCINOMA


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Abstract

Results of treatment of 32 patients after nephrectomy with thrombectomy for renal cell carci-noma complicated by tumor thrombosis of the inferior vena cava were analyzed. The study in-cluded patients only with II - IV clot levels: 26 patients with T3b - the length of the thrombus 5.1 ±1.75 cm, 6 patients with T3c - the length of a thrombus - 14.8± 0.98 cm. One patient (3.1%) died due to pulmonary artery thromboembolia in immediate postoperative period. 1-2 degrees Clavier Complications were observed in 11 patients, 3-4 degree - in two (6.2%) patients. 90.4% of patients had metastases in distant organs and (or) in the regional lymph nodes, which nega-tively affected the survival rates of patients - 5-year survival rate was 36%. The presence of lymphogenous metastases, MSKCC criteria were factors affecting survival rate. Survival rates of patients with T3b and T3C levels were not statistically different. The results of postoperative systemic targeted therapy were significantly statistically better than the results of immunotherapy.

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References

  1. Чиссов В.И. Злокачественные новообразования в России в 2007 г. Чиссов В.И., Старинский В.В., Петрова Г.В. М., 2008.
  2. Ljungberg B. et al. Guidelines on Renal Cell Carcinoma. EAU Guidelines. 2011 ;1—4.
  3. Матвеев В.Б. Опухоли почечной паренхимы. В.Б. Матвеев. Клиническая онкоурлогия под ред. Б. П. Матвеева. М.: Вердана, 2003;24—174.
  4. Nesbitt J.C. et al. Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. Ann. Thorac. Surg. 1997; 63:1592-1600.
  5. Blute M.L. et al. The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int. 2004; 94:33-41.
  6. Boorjian S.A. Renal cell carcinoma: vena caval involvement. Boorjian S.A., Sengupta S., Blute M.L. BJU Int. 2007;99:1239-1244.
  7. Skinner D.G. et al. Vena caval involvement by renal cell carcinoma. Surgical resection provides meaningful long-term surviva. Ann Surg. 1989;210:387-392.
  8. Glazer A.A. Long-term follow-up after surgical treatment for renal cell carcinoma extending into the right atrium. Glazer A.A., Novick A.C. J. Urol. 1995; 155:448.
  9. Sobin L.H. et al. TNM classification of malignant tumors. UICC International Union Against Cancer. 7th edn. Wiley-Blackwell. 2009; 255-257.
  10. Goldfarb D.A. et al. Magnetic resonance imaging for assessment of vena caval tumor thrombi: a comparative study with vena cavography and CT scanning. J. Urol. 1990;144:1110.
  11. Guzzo T.J. et al. The accuracy of multidetector computerized tomography for evaluating tumor thrombus in patients with renal cell carcinoma. J. Urol. 2009;181: 486-90.
  12. Dindo D. Classification of Surgical Complications. A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Dindo D., Demartines N., Clavien P.A. Ann. Surg. 2004; 240(2):205—213.
  13. Кулаичев А.П. Статистическая диалоговая система STADIA 4.5. А.П. Кулаичев. Руководство пользователя. НПО Информатика и компьютеры. М., 1991.
  14. Granberg C.F. et al. Surgical management, complications, and outcome of radical nephrectomy with inferior vena cava tumor thrombectomy facilitated by vascular bypass. Urology. 2008;72(1):148-152.
  15. Gallucci M. et al. Liver harvesting surgical technique for the treatment of retro-hepatic caval thrombosis concomitant to renal cell carcinoma: perioperative and long-term results in 15 patients without mortality. Eur. Urol. 2004; 45(2):194-202.
  16. Sweeney P. et al. Surgical management of renal cell carcinoma associated with complex inferior vena caval thrombi. Urol. Oncol. 2003;21(5):327-333.
  17. Naitoh J. et al. Metastatic renal cell carcinoma with concurrent inferior vena caval inva-sion: long-term survival after combination therapy with radical nephrectomy, vena caval thrombectomy and postoperative immunotherapy. J. Urol. 1999;162(1):46-50.
  18. Zisman A. et al. Renal cell carcinoma with tumor thrombus extension: biology, role of nephrectomy and response to immunotherapy. J Urol. 2003;169(3):909-916.
  19. Haferkamp A. et al. Renal Cell Carcinoma With Tumor Thrombus Extension Into the Vena Cava: Prospective Long-Term Follow-up. J. Urol. 2007;177(5) 1703-1708.
  20. Tanaka M. et al. Prognostic factors of renal cell carcinoma with extension into inferior vena cava. International Journal of Urology: Official Journal of the Japanese Urological Association. 2008;15(5):394-398.
  21. Moinzadeh A. Prognostic significance of tumor thrombus level in patients with renal cell carcinoma and venous tumor thrombus extension. Is all T3b the same? Moinzadeh A., Libertino J.A. J. Urol. 2004;171(2 Pt 1):598-601.
  22. Karakiewicz P.I. et al. Neoadjuvant sutent induction therapy may effectively down-stage renal cell carcinoma atrial thrombi. Eur. Urol. 2008;53:845-848.
  23. Shuch B. et al. Neoadjuvant targeted therapy and advanced kidney cancer: observations and implications for a new treatment paradigm. BJU Int. 2008;102:692-696.
  24. Kapoor A., Gharajeh A., Sheikh A. et al. Adjuvant and neoadjuvant small-molecule tar-geted therapy in high-risk renal cell carcinoma. Curr Oncol. 2009;16(Suppl.1):S60-66.
  25. Wood C.G. Multimodal approaches in the management of locally advanced and metas-tatic renal cell carcinoma: combining surgery and systemic therapies to improve patient outcome. Clin. Cancer Res. 2007;13(2 Pt 2):697-702.
  26. Bex A. et al. Integrating surgery with targeted therapies for renal cell carcinoma: current evidence and ongoing trials. Eur. Urol. 2010;58(6):819-828.
  27. Wagner B. et al. Prognostic value of renal vein and inferior vena cava involvement in renal cell carcinoma. Eur. Urol. 2009; 55(2):452—459.

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