A contemporary evaluation of cytoreductive nephrectomy with tumor thrombus: Morbidity and long-term survival.
BACKGROUND
Metastatic renal cell carcinoma (RCC) is an aggressive entity that frequently invades the venous system. We evaluated the morbidity and survival of patients with tumor thrombus who undergo cytoreductive nephrectomy.


METHODS
We identified 56 patients from our institution's database who had a primary renal tumor in place and documented metastases at the time of surgery. We reviewed demographic and pathologic characteristics from these patients as well as complications and overall survival.


RESULTS
Median age was 58 (37-77). There were 33 patients (59%) who had tumor thrombus with 21 (64%) involving the renal vein, 10 (30%) involving the infradiaphragmatic inferior vena cava (IVC), and 2 (6%) involving the supradiaphragmatic IVC. Median tumor size for thrombus patients was 12 cm (5-29). There were 8 (14.2%) who had complications, including 1 death. Thrombus patients were significantly more likely to have a complication (P = 0.008). Median survival for all patients was 10.7 months (0.3-61). There was no significant difference in overall survival between patients with and without thrombus (P = 0.76).


CONCLUSIONS
Patients who undergo cytoreductive nephrectomy with a tumor thrombus have a higher rate of complications as compared to patients undergoing cytoreductive nephrectomy without tumor thrombus. The long-term survival, however, was not statistically different and thus aggressive surgery for select metastatic RCC patients is warranted.
Department of Urology, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA.
Manlio A
MA
Goetzl
Erik T
ET
Goluboff
Alana M
AM
Murphy
Aaron E
AE
Katz
Mahesh
M
Mansukhani
Ihor S
IS
Sawczuk
Carl A
CA
Olsson
Mitchell C
MC
Benson
James M
JM
McKiernan
D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009392:Nephrectomy; D012189:Retrospective Studies; D016019:Survival Analysis; D013927:Thrombosis / Q000209:etiology*