title: Multi-disciplinary surgical approach to the management of patients with renal cell carcinoma with venous tumor thrombus: 15 year experience and lessons learned.
abstract: BACKGROUND
  The management of patients with renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is challenging. We report our 15 year experience in the management of patients with RCC with VTT utilizing a multidisciplinary team approach, highlighting improved total and specifically Clavien III-V complication rates.
  
  
  METHODS
  We reviewed the records of 146 consecutive patients who underwent radical nephrectomy with venous thrombectomy between 1998 and 2012. Data on patient history, staging, surgical techniques, morbidity, and survival were analyzed. Additionally, complication rates between two surgical eras, 1998-2006 and 2006-2012, were assessed.
  
  
  RESULTS
  The study included 146 patients, 97 males (66 %), and a median age of 61 years (range, 24-83). Overall complications rate was 53 %, high grade complications (Clavien III -V) occurred in 10 % of patients. Most importantly, there was a lower incidence of overall and high grade complications (45 % and 8 %, respectively) in the last 6 years compared to the earlier surgeries included in the study (67 % and 13 % respectively) [p = .008 and .03, respectively). 30 day postoperative mortality was 2.7 %. 5 year overall survival (5Y- OS) and 5 year cancer specific survival (5Y- CSS) were 51 % and 40 %, respectively. Metastasis was the only independent predictor factor for CSS (HR 3.8, CI 1.9-7.6 and p < .001) and OS (HR 2.6, CI 1.5-4.7 and p = .001) in all patients.
  
  
  CONCLUSIONS
  Our data suggest that patients with RCC and VTT can be treated safely utilizing a multidisciplinary team approach leading to a decrease in complication rates.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA.
authors.forename: Bishoy A
authors.initials: BA
authors.lastname: Gayed
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA.
authors.forename: Ramy
authors.initials: R
authors.lastname: Youssef
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA.
authors.forename: Oussama
authors.initials: O
authors.lastname: Darwish
authors.affiliation: Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Payal
authors.initials: P
authors.lastname: Kapur
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Bagrodia
authors.affiliation: Departments of Medicine and Developmental Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: James
authors.initials: J
authors.lastname: Brugarolas
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Raj
authors.affiliation: Departments of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: J Michael
authors.initials: JM
authors.lastname: DiMaio
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Sagalowsky
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA. vitaly.margulis@utsouthwestern.edu.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D009392:Nephrectomy; D010348:Patient Care Team; D012189:Retrospective Studies; D017131:Thrombectomy; D013997:Time Factors; D020246:Venous Thrombosis / Q000209:etiology*; D055815:Young Adult
keywords: IVC thrombus; Outcomes; Renal cell carcinoma