title: Surgery for renal cell cancer extending into the inferior vena cava - evaluation of survival and perioperative complications using a standardized classification system.
abstract: OBJECTIVE
  • To present a single-centre experience of surgery for kidney cancer involving vena cava thrombus with surgical technique, complications and outcome using a standardized classification system for perioperative complications.
  
  
  METHODS
  • Sixty-eight consecutive cases were retrospectively analysed. Thrombus extension was at level I (but inside the vena cava) in 10 cases, level II in 28 cases, level III in 18 cases and level IV in 12 cases; 18 patients had distant metastases. • Radical tumour nephrectomy was performed in all cases. Complete liver mobilization was carried out in 23 cases and cardiovascular bypass with circulatory arrest was performed in five cases. • Follow-up was available for 66 patients. Median follow-up was 29 months (interquartile range 30.75).
  
  
  RESULTS
  • The 28-day mortality was 0%. • According to the Clavien-Dindo classification there were two grade 1, 54 grade 2, two grade 3a, two grade 3b and two grade 4a perioperative complications. • The factors pN, grading and metastases at presentation predicted overall survival in univariate analyses. In a multivariate model none of the factors age, metastases at presentation, pN, WHO-grading, American Society of Anesthesiologists score, tumour size and thrombus level significantly predicted survival. • Immediate target therapy with neoadjuvant intention in three patients did not result in surgical therapy.
  
  
  CONCLUSIONS
  • Aggressive surgical treatment causes no perioperative mortality and leads to a low rate of grade 3 and grade 4 complications (8.8%). • A median overall survival of 47 months shows that surgical treatment has favourable results in these patients.
authors.affiliation: University Hospital 'Carl Gustav Carus', Department of Urology, Dresden, Germany. stefan.zastrow@uniklinikum-dresden.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Zastrow
authors.forename: Steffen
authors.initials: S
authors.lastname: Leike
authors.forename: Sven
authors.initials: S
authors.lastname: Oehlschläger
authors.forename: Marc-Oliver
authors.initials: MO
authors.lastname: Grimm
authors.forename: Manfred
authors.initials: M
authors.lastname: Wirth
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000401:mortality*; D059035:Perioperative Period / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D017131:Thrombectomy; D014682:Vena Cava, Inferior / Q000601:surgery; D020246:Venous Thrombosis / Q000401:mortality* / Q000601:surgery