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Clinical management of renal cell carcinoma with venous tumor thrombus

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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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Authors and Affiliations

  1. Department of Urology, Yale School of Medicine, 310 Cedar Street 238A, New Haven, CT, 06510, USA

    Nnenaya Agochukwu & Brian Shuch

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  1. Nnenaya Agochukwu
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  2. Brian Shuch
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Correspondence to Brian Shuch.

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Agochukwu, N., Shuch, B. Clinical management of renal cell carcinoma with venous tumor thrombus. World J Urol 32, 581–589 (2014). https://doi.org/10.1007/s00345-014-1276-7

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  • DOI: https://doi.org/10.1007/s00345-014-1276-7

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