title: Increased risk of preoperative venous thromboembolism in patients with renal cell carcinoma and tumor thrombus.
abstract: BACKGROUND
  The clinical impact of a tumor thrombus in renal cell carcinoma (RCC) patients awaiting radical nephrectomy and thrombectomy is unknown.
  
  
  OBJECTIVE
  To determine the incidence of venous thromboembolism (VTE) in RCC patients with tumor thrombus prior to nephrectomy.
  
  
  METHODS
  We conducted a retrospective cohort study including all late-stage (stage 3-4 excluding T1-2 N0M0) RCC patients who underwent radical nephrectomy at our institution between 1 January 2005 and 1 July 2012. Tumor thrombus was defined as the presence of an intraluminal filling defect in the renal vein, hepatic vein, portal vein, or inferior vena cava, directly extending from a renal mass detected on computed tomography.
  
  
  RESULTS
  A total of 176 patients were included in the study. Fifty-three (30.1%) patients had tumor thrombus diagnosed on imaging Three patients with tumor thrombus (5.7%; 95% confidence interval [CI] 1.4-16.8) developed a VTE while awaiting radical nephrectomy, whereas none (0%; 95% CI 0-2.9) of the patients without a tumor thrombus had an event (P = 0.026). All three events were deep vein thrombosis. Times from tumor thrombus diagnosis to VTE were 5, 15 and 21 days.
  
  
  CONCLUSIONS
  Tumor thrombus on imaging is a frequent finding among RCC patients awaiting nephrectomy. The presence of tumor thrombus in these patients increases the incidence of preoperative VTE.
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: D W
authors.initials: DW
authors.lastname: Yokom
authors.forename: R
authors.initials: R
authors.lastname: Ihaddadene
authors.forename: P
authors.initials: P
authors.lastname: Moretto
authors.forename: C M
authors.initials: CM
authors.lastname: Canil
authors.forename: N
authors.initials: N
authors.lastname: Reaume
authors.forename: G
authors.initials: G
authors.lastname: Le Gal
authors.forename: M
authors.initials: M
authors.lastname: Carrier
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012189:Retrospective Studies; D013927:Thrombosis / Q000150:complications*; D054556:Venous Thromboembolism / Q000209:etiology*
keywords: neoplasm; nephrectomy; renal cell carcinoma; thrombosis; venous thromboembolism