Contemporary techniques and outcomes of surgery for locally advanced renal cell carcinoma with focus on inferior vena cava thrombectomy: The value of a multidisciplinary team.
Inferior vena cava
Liver transplant
Nephrectomy
Open surgery
Renal cell carcinoma
Thrombectomy
Journal
Asian journal of urology
ISSN: 2214-3882
Titre abrégé: Asian J Urol
Pays: Singapore
ID NLM: 101699720
Informations de publication
Date de publication:
Jul 2022
Jul 2022
Historique:
received:
03
02
2022
revised:
31
03
2022
accepted:
23
05
2022
entrez:
29
8
2022
pubmed:
30
8
2022
medline:
30
8
2022
Statut:
ppublish
Résumé
To report the outcomes of surgery for a contemporary series of patients with locally advanced non-metastatic renal cell carcinoma (RCC) treated at a referral academic centre, focusing on technical nuances and on the value of a multidisciplinary team. We queried our prospective institutional database to identify patients undergoing surgical treatment for locally advanced (cT3-T4 N0-1 M0) renal masses suspected of RCC at our centre between January 2017 and December 2020. Overall, 32 patients were included in the analytic cohort. Of these, 12 (37.5%) tumours were staged as cT3a, 8 (25.0%) as cT3b, 5 (15.6%) as cT3c, and 7 (21.9%) as cT4; 6 (18.8%) patients had preoperative evidence of lymph node involvement. Nine (28.1%) patients underwent nephron-sparing surgery while 23 (71.9%) received radical nephrectomy. A template-based lymphadenectomy was performed in 12 cases, with evidence of disease in 3 (25.0%) at definitive histopathological analysis. Four cases of RCC with level IV inferior vena cava thrombosis were successfully treated using liver transplant techniques without the need for extracorporeal circulation. While intraoperative complications were recorded in 3 (9.4%) patients, no postoperative major complications (Clavien-Dindo ≥3) were observed. At histopathological analysis, 2 (6.2%) patients who underwent partial nephrectomy harboured oncocytoma, while the most common malignant histotype was clear cell RCC (62.5%), with a median Leibovich score of 6 (interquartile range 5-7). Locally advanced RCC is a complex and heterogenous disease posing several challenges to surgical teams. Our experience confirms that provided careful patient selection, surgery in experienced hands can achieve favourable perioperative, oncological, and functional outcomes.
Identifiants
pubmed: 36035338
doi: 10.1016/j.ajur.2022.05.002
pii: S2214-3882(22)00041-8
pmc: PMC9399529
doi:
Types de publication
Journal Article
Langues
eng
Pagination
272-281Informations de copyright
© 2022 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
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