Nephrectomy, inferior vena cava thrombectomy in renal cell carcinoma with tumor venous thrombosis and pulmonary metastases

Objective: to assess advisability of nephrectomy, inferior vena cava (IVC) thrombectomy in renal cell carcinoma (RCC) with tumor venous thrombosis and pulmonary metastases. Materials and methods. We analyzed medical data of 112 consecutive RCC patients with tumor venous thrombosis and pulmonary metastases undergone nephrectomy, IVC thrombectomy at N.N. Blokhin Cancer Center from 1971 to 2014. Median age was 57 (19-77) years, a male-to-female ratio -4.1:1. Tumor venous thrombosis occurred in all patients and achieved levels III-IV in 36 (32.1 %) cases. Ten (8.9 %) patients had solitary, 102 (91.1 %) - multiple lung metastases. Nephrectomy, thrombectomy was performed in all cases, 10 (8.9 %) patients also underwent complete resection of all pulmonary lesions. Eighty-eight (78.6 %) patients managed to receive systemic therapy. Median follow-up - 24 (3-148) months. Results. Median operative time was 185 (70-380) min, median blood loss - 4000 (200-18 000) ml. Intraoperative complications occurred in 25 (22.3 %), postoperative - in 37 (33.0 %) patients (Clavien-Dindo grade III-V - 27 (24.1 %)). Mortality rate was 9.8 %. Five-years overall and cancer-specific survival in all patients were 22.3 and 24.0 % respectively (median - 21.0 +/- 3.6 and 21.0 +/- 2.9 months respectively). Independent negative prognostic factors for cancer-specific survival were tumor pulmonary embolism before surgery (hazard ratio 269.4; 95 % confidence interval 112.4-314.6; p = 0.021) and contralateral renal vein tumor thrombosis (hazard ratio 83.1; 95 % confidence interval 78.2-178.3; p = 0.011). Conclusion. Nephrectomy, IVC thrombectomy is justified in selected RCC patients with tumor venous thrombosis and lung metastases without pulmonary embolism before surgery and contralateral renal vein tumor thrombosis. Nephrectomy, IVC thrombectomy is associated with acceptable complications rate and provides long-term survival comparable with the results of simple cytoreductive nephrectomies in historical series.