title: Fate of newly developed pulmonary embolism after surgery for renal cell carcinoma with vena cava thrombus.
abstract: OBJECTIVE
  Pulmonary embolism with viable tumor cells developed after surgery for renal cell carcinoma may metastasize to lung. We investigated the incidence and fate of newly developed pulmonary embolism after surgery for renal cell carcinoma with vena cava thrombus.
  
  
  METHODS
  Among 4549 renal cell carcinoma patients treated with curative surgery at our institute from 1998 to 2015, 81 non-metastatic renal cell carcinoma patients with vena cava thrombus were included. The clinical course of pulmonary embolism and its impact on oncological outcomes were assessed.
  
  
  RESULTS
  Postoperatively, pulmonary embolism developed in 13 patients (16.0%), who had higher level of vena cava thrombus (p = 0.004), more frequent liver mobilization (p = 0.005), and higher amount of intraoperative transfusion (p = 0.024) than patients without pulmonary embolism. The rate of lung metastasis was similar between patients with and without pulmonary embolism (30.8 vs. 35.3%, p = 1.000). In the multivariate analysis, the significant risk factors for disease recurrence were non-clear cell histology (p = 0.014) and larger primary renal tumor size (p = 0.032). Non-clear cell histology (p = 0.003) was the only significant risk factor for cancer-specific survival. Pulmonary embolism was not associated with both recurrence-free and cancer-specific survival.
  
  
  CONCLUSIONS
  Pulmonary embolism after surgery for renal cell carcinoma with vena cava thrombus was not associated with worse oncological outcomes and can be closely followed up with anticoagulation therapy.
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Sangjun
authors.identifier: http://orcid.org/0000-0003-4992-7053
authors.initials: S
authors.lastname: Yoo
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea. mdexodus@naver.com.
authors.forename: Sang Hoon
authors.identifier: http://orcid.org/0000-0003-4888-483X
authors.initials: SH
authors.lastname: Song
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Heounjeong
authors.identifier: http://orcid.org/0000-0003-0412-8709
authors.initials: H
authors.lastname: Go
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Dalsan
authors.identifier: http://orcid.org/0000-0001-8152-847X
authors.initials: D
authors.lastname: You
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Cheryn
authors.identifier: http://orcid.org/0000-0002-1823-4281
authors.initials: C
authors.lastname: Song
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Jun Hyuk
authors.identifier: http://orcid.org/0000-0003-2705-0481
authors.initials: JH
authors.lastname: Hong
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Choung-Soo
authors.identifier: http://orcid.org/0000-0002-7464-3207
authors.initials: CS
authors.lastname: Kim
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Hanjong
authors.identifier: http://orcid.org/0000-0001-7608-5352
authors.initials: H
authors.lastname: Ahn
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: In Gab
authors.identifier: http://orcid.org/0000-0003-4093-832X
authors.initials: IG
authors.lastname: Jeong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008175:Lung Neoplasms / Q000209:etiology* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D009360:Neoplastic Cells, Circulating; D011183:Postoperative Complications / Q000209:etiology*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D012307:Risk Factors; D015996:Survival Rate; D047368:Tumor Burden; D014684:Venae Cavae
keywords: Inferior vena cava; Pulmonary embolism; Renal cell carcinoma; Thrombectomy