Radical nephrectomy with vena caval thrombectomy: a contemporary experience.
OBJECTIVE
• To report on the contemporary Memorial Sloan-Kettering Cancer Center experience with radical nephrectomy and vena caval thrombectomy.


METHODS
• Patients who underwent radical nephrectomy and vena caval thrombectomy without the use of bypass techniques were retrospectively identified. • Data were collected on intraoperative and pathological findings as well as postoperative complications and oncological outcomes.


RESULTS
• In all, 78 patients underwent radical nephrectomy with off-bypass resection of vena caval thrombus between 1989 and 2009. • The median (interquartile range, IQR) operation duration was 293 (226-370) min, and median (IQR) blood loss was 1300 (750-2500) mL. In all, 10 patients (13%) were confirmed to have intra- or supra-hepatic tumour thrombus (level 3/4), eight of whom required supra-hepatic control of the inferior vena cava (IVC). • Major (grade 3-5) postoperative complications occurred in 14 (18%), with five postoperative deaths. Disease recurred in 27/62 patients who were considered completely resected at surgery and had adequate follow-up. • The overall 5-year survival (95% confidence interval) probability was 48% (35-60%).


CONCLUSIONS
• Radical nephrectomy with vena caval thrombectomy is associated with acceptable postoperative morbidity and mortality, and long-term survival is possible in some patients. • Many level 3/4 thrombi could be safely approached without the use of bypass techniques.
Kaag
Matthew G
MG
Urology Service and Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Toyen
Christien
C
Russo
Paul
P
Cronin
Angel
A
Thompson
R Houston
RH
Schiff
Jeffrey
J
Bernstein
Melanie
M
Bains
Manjit
M
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D013927:Thrombosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology* / Q000601:surgery