title: Surgical outcomes after cytoreductive nephrectomy with inferior vena cava thrombectomy.
abstract: OBJECTIVE
  To determine postoperative outcomes in patients with metastatic renal cell carcinoma (mRCC) and level II through IV inferior vena cava (IVC) thrombus (IVCT), and their ability to receive systemic therapy.
  
  
  METHODS
  We reviewed medical records of all patients with mRCC and level II through IV IVCT who underwent surgery between January 1990 and December 2012 at our institution. Complications within 30 days of surgery were recorded according to the Clavien-Dindo system. Survival was calculated according to the Kaplan-Meier method, and intergroup comparisons were performed with the log-rank statistics.
  
  
  RESULTS
  Seventy-six patients were identified, of which 30 (40%), 31 (41%), and 15 (20%) patients had a level II, III, and IV IVCT, respectively. Perioperative mortality was 6.6%. The overall postoperative complication rate was 37%, of which 7.8% (n = 6) were classified as major postoperative complications (Clavien grade 3-5). Follow-up information was available in 60 patients, of whom 90% received a postoperative systemic therapy. Four patients chose expectant management, and 2 patients died of progressive disease before receiving systemic therapy. Overall median survival was 14 months and was significantly related to postoperative treatment with targeted molecular therapies and number of prognostic risk factors, but was not influenced by the level of IVC tumor thrombus.
  
  
  CONCLUSIONS
  Cytoreductive nephrectomy and IVC thrombectomy can be performed with acceptable complication rates and should be considered as an integral part of the treatment approach for patients with mRCC and IVC tumor thrombi.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Karin E
authors.initials: KE
authors.lastname: Westesson
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Klink
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Transplant Center, Cleveland Clinic, Cleveland, OH.
authors.forename: John C
authors.initials: JC
authors.lastname: Rabets
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Amr F
authors.initials: AF
authors.lastname: Fergany
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Stephenson
authors.affiliation: Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH.
authors.forename: Brian I
authors.initials: BI
authors.lastname: Rini
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland OH.
authors.forename: Jose
authors.initials: J
authors.lastname: Navia
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Transplant Center, Cleveland Clinic, Cleveland, OH. Electronic address: krishnv@ccf.org.
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Krishnamurthi
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D009392:Nephrectomy / Q000379:methods; D018579:Patient Selection; D011183:Postoperative Complications / Q000469:parasitology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D017131:Thrombectomy / Q000379:methods; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*