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№3' 2016
ONCOLOGYInternational Medical Journal, Vol. 22., Iss. 3, 2016, P. 48−54.
THE OVERALL RESULTS OF SURGICAL TREATMENT OF RENAL CELL CARCINOMA WITH INTRAVENOUS PROLIFERATION
Kharkiv National Medical University
V. I. Shapoval Regional Center for Urology and Nephrology, Ukraine
The authors present a retrospective study to evaluate perioperative complications of surgical treatment of RCC with tumor thrombi, as well as to study oncological properties including overall survival and progression−free survival of patients. One hundred and thirty−two patients with intravenous proliferation of renal cell carcinoma were included into the study. The whole population was stratified into two groups: 1 −− tumor thrombi restricted to the renal vein only (n = 63), and 2 −− tumor thrombi of the inferior vena cava (n = 63). All patients underwent surgery with the use of Chevron incision without cardiopulmonary bypass. In cases of retrohepatic thrombi or higher, the classic and piggyback techniques of liver mobilization were applied. The access to the right atrium was performed through the diaphragm from the abdomen. The average follow−up period of all the patients that were included into the survival analysis was 30.6±5.6 months. The overall level of perioperative complications in patients with macroscopic tumor thrombi reached 56.8 %. The frequency of complications was statistically significantly higher in cases of the tumor extending into the IVC (p < 0.05). The overall survival median in the whole group was 48.0 months (Me = 48; Q25−75 = 30−60), and progression−free survival median was 30.0 months (Me = 30; Q25−75 = 18−48). Total 2− and 5−year metastasis−free survival rate did not exceed 83.8 %, and 36.9 %, respectively, with relapse−free survival rate of 73.3 %, and 13.5 %. Survival rates did not differ significantly in the renal vein thrombi groups, and the IVC thrombi groups (p > 0.759 for overall survival, and p > 0.062 for progression−free survival). Univariant analysis results demonstrated the predictive value of the factors such as the ECOG scale status, histological grading of the tumor, tumor invasion into the wall of the IVC, and the level of thrombus in the IVC. However, in the multivariant analysis the statistical significance of the IVC level thrombi only (retrohepatic segment of the IVC, and the segment above/below the retrohepatic IVC) (р < 0.0474) was presented.
Key words: tumor thrombus, inferior vena cava, renal cell carcinoma