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Update on Surgical Management of Renal Cell Carcinoma with Venous Extension

  • Kidney Diseases (G Ciancio, Section Editor)
  • Published:
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Abstract

Intravenous extension of renal cell carcinoma remains one of the most intense debate topics in urologic oncology. In the absence of effective alternative treatment, complete surgical removal of the primary tumor with its extension along the vena cava is the only hope for a potential cure. For this reason, an aggressive approach has been established as the mainstay of treatment. Recent advances in the understanding of the biology of intravascular tumor invasion and the considerable progress in the fields of diagnosis and treatment of this entity, with innovative surgical and systemic strategies, have completely redefined the management of these patients. A PubMed-MEDLINE search was conducted to identify relevant articles on the preoperative assessment and surgical management of renal cell carcinoma with intravenous tumor extension to provide updated knowledge on this always challenging topic.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Gupta K, Miller JD, Li JZ, et al. Epidemiologic and socioeconomic burden of metastatic renal cell carcinoma (mRCC): a literature review. Cancer Treat Rev. 2008;34:193–205.

    Article  PubMed  Google Scholar 

  2. Kim HL, Zisman A, Han KR, et al. Prognostic significance of venous thrombus in renal cell carcinoma. Are renal vein and inferior vena cava different? J Urol. 2004;171:588–91.

    Article  PubMed  Google Scholar 

  3. • Pouliot F, et al. Contemporary management of renal tumors with venous tumor thrombus. J Urol. 2010;184:833–841. This is a recent review on RCC with intracaval extension focusing on diagnosis and treatment of this disease.

    Article  PubMed  Google Scholar 

  4. Boorjian SA, Blute ML. Surgery for vena caval tumor extension in renal cancer. Curr Opin Urol. 2009;19:473–7.

    Article  PubMed  Google Scholar 

  5. Abreu SC, Gill IS. Renal cell carcinoma: modern surgical approach. Curr Opin Urol. 2003;13:439–44.

    Article  PubMed  Google Scholar 

  6. • Martínez-Salamanca JI, et al. Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension. Eur Urol. 2010; doi:10.1016/j.eururo.2010.10.001. This is an analysis of the largest cohort of patients with RCC and IVC tumor thrombus in terms of survival and the different prognostic factors.

  7. Zisman A, Pantuck AJ, Chao DH, et al. Renal cell carcinoma with tumor thrombus: is cytoreductive nephrectomy for advance disease associated with an increased complication rate? J Urol. 2002;168:962–7.

    Article  PubMed  Google Scholar 

  8. Lambert EH, Perorazio PM, Shabsigh, et al. Prognostic risk stratification and clinical outcomes in patients undergoing surgical treatment of renal cell carcinoma with vascular tumor thrombus. Urology. 2007;69:1054–8.

    Article  PubMed  Google Scholar 

  9. • Rini BI, Campbell SC, Escudier B. Renal cell carcinoma. Lancet 2009;373:1119–32. This is a current and extensive review on the different aspects involving RCC.

    Article  PubMed  CAS  Google Scholar 

  10. Lam JS, Klatte T, Kim HL, et al. Prognostic factors and selection for clinical studies of patients with kidney cancer. Crit Rev Oncol Hematol. 2008;65:235–62.

    Article  PubMed  Google Scholar 

  11. Klatte T, Pantuck AJ, Riggs SB, et al. Prognostic factors for renal cell carcinoma with tumor thrombus extension. J Urol. 2007;178:1189–95.

    Article  PubMed  Google Scholar 

  12. Haferkamp A, Bastian PJ, Jakobi H, et al. Renal cell carcinoma with tumor thrombus extension into the vena cava: prospective long-term follow up. J Urol. 2007;177:1703–8.

    Article  PubMed  Google Scholar 

  13. Ficarra V, Novara G, Iafrate M, et al. Proposal for reclassification of the TNM staging system in patients with locally advanced (pT3-4) renal cell carcinoma according to the cancer related outcome. Eur Urol. 2007;51:722–9.

    Article  PubMed  Google Scholar 

  14. Margulis V, Tamboli P, Matin SF, et al. Redefining pT3 renal cell carcinoma in the modern era: a proposal for a revision of the TNM primary tumor classification system. Cancer. 2007;109:2439–44.

    Article  PubMed  Google Scholar 

  15. Mueller-Lisse UG, Mueller-Lisse UL. Imaging of advanced renal cell carcinoma. World J Urol. 2010;28:253–61.

    Article  PubMed  Google Scholar 

  16. • Woodruff DY, Van Veldhuizen P, Meuhlebach G, et al. The perioperative management of an inferior vena caval tumor thrombus in patients with renal cell carcinoma Urol Oncol. 2011;doi:10.1016/j.urolonc.2011.03.006. This paper provides a practice guideline to deal with the perioperative management of patients with RCC and intracaval extension.

  17. Thompson RH, Hartmann RP, Lowe VJ, Kawashima A, Leibowich BC. Application of positron emission tomography imaging, intraoperative ultrasound, magnetic resonance imaging and angiography in the evaluation of renal masses. Curr Urol Rep. 2004;5:30–4.

    Article  PubMed  Google Scholar 

  18. Thompson RH, Cheville JC, Lohse CM, et al. Reclassification of patients with pT3 and pT4 renal cell carcinoma improves prognostic accuracy. Cancer. 2005;104:53–60.

    Article  PubMed  Google Scholar 

  19. Moch H, Artibani W, Delahunt B, et al. Reassessing the current UICC/AJCC TNM staging for renal cell carcinoma. Eur Urol. 2009;56:636–43.

    Article  PubMed  Google Scholar 

  20. Wagner B, Patard JJ, Mejean A, et al. Prognostic value of renal vein and inferior vena cava involvement in renal cell carcinoma. Eur Urol. 2009;55:452–9.

    Article  PubMed  Google Scholar 

  21. • Sobin LH, Gospodariwicz M, Wittekind C (eds). TNM classification of malignant tumors. UICC International Union Against Cancer. 7th edn. Wiley-Blackwell, 2009;255–257. This article provides the current TNM classification for RCC.

  22. Neves RJ, Zincke H. Surgical treatment of renal cancer with vena cava extension. Br J Urol. 1987;59:390–5.

    Article  PubMed  CAS  Google Scholar 

  23. Subramanian VS, Stephenson AJ, Goldfarb DA, et al. Utility of preoperative renal artery embolization for management of renal tumors with inferior vena caval thrombi. Urology. 2009;74:154–9.

    Article  PubMed  Google Scholar 

  24. Schwartz MJ, Smith EB, Trost DW, et al. Renal artery embolization: clinical indication and experience from over 100 cases. BJU Int. 2007;99:881–6.

    Article  PubMed  Google Scholar 

  25. Motzer RJ, Hutson TE, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 2007;356:115–24.

    Article  PubMed  CAS  Google Scholar 

  26. Motzer RJ, Rini BI, Bukowsky RM, et al. Sunitinib in patients with patients with metastatic renal cell carcinoma. JAMA. 2006;295:2516–24.

    Article  PubMed  CAS  Google Scholar 

  27. Escudier B, Eisen T, Stadler WM, et al. Sorafenib in advanced clear-cell renal cell carcinoma. New Eng J Med. 2007;356:125–34.

    Article  PubMed  CAS  Google Scholar 

  28. • Abaza R. Robotic surgery and minimally invasive management of renal tumors with vena caval extension. Curr Op Urol. 2011;21:104–9. This is a current review on the state-of-the-art minimally invasive approaches to RCC with caval invasion.

    Article  Google Scholar 

  29. • Gonzalez J, Angulo J, Ciancio G. Surgical management of renal cell cancer with tumor thrombus through an exclusive transabdominal approach. Arch Esp Urol. 2011;64: 297–309. This is a step-by-step description of the special surgical maneuvers derived from transplant surgery that could be useful in patients with neoplastic extension of an RCC.

    PubMed  Google Scholar 

  30. Vaidya A, Ciancio G, Soloway M. Surgical techniques for treating a renal neoplasm invading the inferior vena cava. J Urol. 2003;169:435–44.

    Article  PubMed  Google Scholar 

  31. Bachmann A, Seitz M, Graser A, et al. Tumor nephrectomy with vena cava thrombus. BJU Int. 2005;95:1373–84.

    Article  PubMed  Google Scholar 

  32. Blute ML, Leibovich BC, Lohse CM, 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.

    Article  PubMed  Google Scholar 

  33. Margulis V, Sanchez-Ortiz RF, Tamboli P, et al. Renal cell carcinoma involving adjacent organs: experience with aggressive surgical management. Cancer. 2007;109:2025–30.

    Article  PubMed  Google Scholar 

  34. •• Ciancio G, Gonzalez J, Shirodkar SP, et al. Liver transplantation techniques for the surgical management of renal cell carcinoma with tumor thrombus in the inferior vena cava: step-by-step description. Eur Urol. 2011;59:401–6. This is an extensive and step-by-step explanation of how to deal with IVC tumor thrombus through an exclusive transabdominal approach.

    Article  PubMed  Google Scholar 

  35. Boorjian SA, Blute ML. Surgery for vena caval tumor extension in renal cancer. Curr Op Urol. 2009;19:473–7.

    Article  Google Scholar 

  36. Ciancio G, Shirodkar SP, Soloway MS, et al. Renal carcinoma with supradiaphragmatic tumor thrombus: avoiding sternotomy and cardiopulmonary bypass. Ann Thorac Surg. 2010;89:505–10.

    Article  PubMed  Google Scholar 

  37. • Gonzalez J, Shirodkar SP, Ciancio G. Multivisceral organ procurement for transplantation derived mobilization maneouvres: very helpful auxiliary techniques in the excision of large retroperitoneal masses. Arch Esp Urol. 2011;64:257–66. This is a description of the different maneuvers and resources for the surgeon to deal with IVC tumor thrombus.

    PubMed  Google Scholar 

  38. •• Ciancio G, Vaidya A, Shirodkar S, et al. En bloc mobilization of the pancreas and spleen to facilitate resection of large tumors, primarily renal and adrenal, in the left upper quadrant of the abdomen: techniques derived from multivisceral transplantation. Eur Urol. 2009;55:1106–11. This is a full description of the mobilization of the pancreas–spleen complex for left big renal masses.

    Article  PubMed  Google Scholar 

  39. Zini L, Destrieux-Garnier L, Leroy X, et al. Renal vein ostium wall invasion of renal cell carcinoma with an inferior vena cava tumor thrombus: prediction by renal and vena cava vein diameters and prognostic significance. J Urol. 2008;179:450–4.

    Article  PubMed  Google Scholar 

  40. Shirodkar SP, Ciancio G, Soloway MS. Vascular stapling of the inferior vena cava: further refinement of techniques for the excision of extensive renal cell carcinoma with unresectable vena-caval involvement. Urology. 2009;74:846–50.

    Article  PubMed  Google Scholar 

  41. Blute ML, Boorjian SA, Leibovich BC, et al. Results of IVC interruption by Greenfield filter, ligation or resection during radical nephrectomy or tumor thrombectomy. J Urol. 2007;178:440–5.

    Article  PubMed  Google Scholar 

  42. Shirodkar SP, Ciancio G. Cardiopulmonary bypass and renal cell carcinoma with level IV tumour thrombus: can deep hypothermic circulatory arrest limit perioperative mortality? BJU Int. 2010;106:879.

    Article  PubMed  Google Scholar 

  43. Granberg CF, Boorgian SA, Schaff HV, et al. Surgical management, complications and outcome of radical nephrectomy with inferior vena cava tumor thrombectomy facilitated by vascular by-pass. Urology. 2008;72:148–52.

    Article  PubMed  Google Scholar 

  44. Chowdhry UK, Mishra AK, Seth A, et al. Novel techniques for tumor thrombectomy for renal cell carcinoma with intraatrial tumor thrombus. Ann Thorac Surg. 2007;83:1731–6.

    Article  Google Scholar 

  45. Bertini R, Roscigno M, Lapenna E, et al. Radical nephrocapsulectomy and caval thrombectomy with extracorporeal circulation and deep hypothermic circulatory arrest in right anterior minithoracotomy: a minimally invasive approach. Urology. 2008;71:957–61.

    Article  PubMed  Google Scholar 

  46. Mazzola A, Gregorini R, Villani C, et al. Cavoatrial tumor thrombectomy with systemic circulatory arrest and antegrade cerebral perfusion. Ann Thorac Surg. 2007;83:1564–5.

    Article  PubMed  Google Scholar 

  47. Kearnes RJ, Blute ML. Surgery insight: management of renal cell carcinoma with associated inferior vena cava thrombus. Nat Clin Pract Urol. 2008;5:329–39.

    Article  Google Scholar 

  48. Shuch B, Larochelle JC, Onyia T, et al. Intraoperative thrombus embolization during nephrectomy and tumor thrombectomy: critical analysis of the University of California-Los Angeles experience. J Urol. 2009;181:492–8.

    Article  PubMed  Google Scholar 

  49. Moinzadeh A, Libertino JA. Prognostic significance of tumor thrombus level in patients with renal cell carcinoma and venous tumor thrombus extension. Is all T3b the same? J Urol. 2004;171:598–601.

    Article  PubMed  Google Scholar 

  50. Sweeney P, Wood CG, Pisters LL, et al. Surgical management of renal cell carcinoma associated with complex inferior vena caval thrombi. Urol Oncol. 2003;21:327–33.

    Article  PubMed  Google Scholar 

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No potential conflicts of interest relevant to this article were reported.

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  1. Servicio de Urología, Hospital Universitario de Getafe, Carretera de Madrid-Toledo Km. 12,500, 28905, Getafe, Madrid, Spain

    Javier González

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  1. Javier González
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Correspondence to Javier González.

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González, J. Update on Surgical Management of Renal Cell Carcinoma with Venous Extension. Curr Urol Rep 13, 8–15 (2012). https://doi.org/10.1007/s11934-011-0222-0

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  • DOI: https://doi.org/10.1007/s11934-011-0222-0

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