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Current Trends in Management of Renal Cell Carcinoma with Venous Thrombus Extension

  • Kidney Diseases (G Ciancio, Section Editor)
  • Published:
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Abstract

Purpose of Review

To review the evidence regarding the current trends in surgical management of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombosis. Recent published series have shown the role of minimally invasive surgery in IVC thrombectomy. This review article evaluates the present RCC with venous extent literature to assess the role of open and minimally invasive surgery in this scenario.

Recent Findings

Robotic urological surgery has shown to have known benefits in radical prostatectomy, partial nephrectomy, and pyeloplasty. Recent published series showed feasibility of robotic IVC thrombectomy even for level IV cases.

Summary

With growing number of robot-assisted and laparoscopic surgeries worldwide, there is a current tendency to treat this complex and challenging pathology with a minimally invasive approach, without compromising oncological outcomes.

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References

  1. Huang WC, Becher E. Current landscape of advanced and metastatic renal cell carcinoma management. Urol Clin North Am. 2020;47(3):xiii-xiv. doi:https://doi.org/10.1016/j.ucl.2020.05.001

  2. Laguna MP, Algaba F, Cadeddu J, Clayman R, Gill I, Gueglio G, et al. Current patterns of presentation and treatment of renal masses: a clinical research office of the endourological society prospective study. J Endourol. 2014;28(7):861–70. https://doi.org/10.1089/end.2013.0724.

    Article  PubMed  Google Scholar 

  3. Ciancio G, Manoharan M, Katkoori D, De Los SR, Soloway MS. Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: single-center experience. Eur Urol. 2010;57(4):667–72. https://doi.org/10.1016/j.eururo.2009.06.009.

    Article  PubMed  Google Scholar 

  4. Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, et al. Laparoscopic nephrectomy: initial case report. J Urol. 1991;146(2):278–82. https://doi.org/10.1016/s0022-5347(17)37770-4.

    Article  CAS  PubMed  Google Scholar 

  5. Abaza R. Initial series of robotic radical nephrectomy with vena caval tumor thrombectomy. Eur Urol. 2011;59(4):652–6. https://doi.org/10.1016/j.eururo.2010.08.038.

    Article  PubMed  Google Scholar 

  6. Laird A, Choy KCC, Delaney H, Cutress ML, O’Connor KM, Tolley DA, et al. Matched pair analysis of laparoscopic versus open radical nephrectomy for the treatment of T3 renal cell carcinoma. World J Urol. 2015;33:25–32. https://doi.org/10.1007/s00345-014-1280-y.

    Article  CAS  PubMed  Google Scholar 

  7. Bragayrac LA, Abbotoy D, Attwood K, et al. Outcomes of minimal invasive vs open radical nephrectomy for the treatment of locally advanced renal-cell carcinoma. J Endourol. 2016;30(8):871–6. https://doi.org/10.1089/end.2016.0082.

    Article  PubMed  Google Scholar 

  8. Becher E, Jericevic D, Huang WC. Minimally invasive surgery for patients with locally advanced and/or metastatic renal cell carcinoma. Urol Clin North Am. 2020;47(3):389–97. https://doi.org/10.1016/j.ucl.2020.04.004.

    Article  PubMed  Google Scholar 

  9. Hevia V, Ciancio G, Gómez V, Álvarez S, Díez-Nicolás V, Burgos FJ. Surgical technique for the treatment of renal cell carcinoma with inferior vena cava tumor thrombus: tips, tricks and oncological results. Springerplus. 2016;5:132. Published 2016 Feb 20. doi:https://doi.org/10.1186/s40064-016-1825-1

  10. Sundaram CP, Rehman J, Landman J, Oh J. Hand assisted laparoscopic radical nephrectomy for renal cell carcinoma with inferior vena caval thrombus. J Urol. 2002;168(1):176–9.

    Article  Google Scholar 

  11. Martin GL, Castle EP, Martin AD, Desai PJ, Lallas CD, Ferrigni RG, et al. Outcomes of laparoscopic radical nephrectomy in the setting of vena caval and renal vein thrombus: seven-year experience. J Endourol. 2008;22(8):1681–5. https://doi.org/10.1089/end.2008.0035.

    Article  PubMed  Google Scholar 

  12. Xiao X, Zhang L, Chen X, Cui L, Zhu H, Pang D, et al. Surgical management of renal cell carcinoma extending into venous system: a 20-year experience. Scand J Surg. 2018;107(2):158–65. https://doi.org/10.1177/1457496917738922.

    Article  CAS  PubMed  Google Scholar 

  13. Martínez-Salamanca JI, Huang WC, Millán I, Bertini R, Bianco FJ, Carballido JA, et al. Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension. Eur Urol. 2011;59(1):120–7. https://doi.org/10.1016/j.eururo.2010.10.001.

    Article  PubMed  Google Scholar 

  14. Wilkinson CJ, Kimovec MA, Uejima T. Cardiopulmonary bypass in patients with malignant renal neoplasms. Br J Anaesth. 1986;58:461–5.

    Article  CAS  Google Scholar 

  15. Libertino, J. A.: Renal cell cancer with extension into the vena cava. In: Rob & Smith’s operative surgery: urology, 4th ed. Edited by W. S. McDougal. London: Butterworths, p. 127, 1986.

  16. Stief CG, Schafers HJ, Kuczyk M. Renal-cell carcinoma with intracaval neoplastic extension: stratification and surgical technique. World J Urol. 1995;13(3):166–70.

    Article  CAS  Google Scholar 

  17. Belis JA, Pae WE, Rohner TJ. Cardiovascular evaluation before circulatory arrest for removal of vena caval extension of renal carcinoma. J Urol. 1989;141(6):1302–7.

    Article  CAS  Google Scholar 

  18. Neves RJ, Zincke H. Surgical treatment of renal cancer with vena cava extension. Br J Urol. 1987;59:390–5.

    Article  CAS  Google Scholar 

  19. Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int. 2004;94(1):33–41. https://doi.org/10.1111/j.1464-410X.2004.04897.

    Article  PubMed  Google Scholar 

  20. Ciancio G, Vaidya A, Savoie M, Soloway M. Management of renal cell carcinoma with level III thrombus in the inferior vena cava. J Urol. 2002;168(4 Pt 1):1374–7. https://doi.org/10.1097/01.ju.0000023441.00587.02.

    Article  PubMed  Google Scholar 

  21. Wang B, Huang Q, Liu K, Fan Y, Peng C, Gu L, et al. Robot-assisted level III-IV inferior vena cava thrombectomy: initial series with step-by-step procedures and 1-yr outcomes. Eur Urol. 2020;78(1):77–86. https://doi.org/10.1016/j.eururo.2019.04.019.

    Article  CAS  PubMed  Google Scholar 

  22. Campi R, Tellini R, Sessa F, et al. Techniques and outcomes of minimally-invasive surgery for nonmetastatic renal cell carcinoma with inferior vena cava thrombosis: a systematic review of the literature. Minerva Urol Nefrol. 2019;71(4):339–358. https://doi.org/10.23736/S0393-2249.19.03396-4.

  23. Abaza R, Eun DD, Gallucci M, Gill IS, Menon M, Mottrie A, et al. Robotic surgery for renal cell carcinoma with vena caval tumor thrombus. Eur Urol Focus. 2016;2(6):601–7. https://doi.org/10.1016/j.euf.2017.01.001.

    Article  PubMed  Google Scholar 

  24. Ciancio G, Hawke C, Soloway M. The use of liver transplant techniques to aid in the surgical management of urological tumors. J Urol. 2000;164(3 Pt 1):665–72. https://doi.org/10.1097/00005392-200009010-00012.

    Article  CAS  PubMed  Google Scholar 

  25. Chan AA, Abel J, Carrasco A, et al. Impact of preoperative renal artery embolization on surgical outcomes and overall survival in patients with renal cell carcinoma and inferior vena cava thrombus. J Urol. 2011;185(Suppl):e707–8.

    Google Scholar 

  26. Tang Q, Li X, Song Y, Wang J, He Z, Zhou L. Application of preoperative renal artery embolization in patients with renal cell carcinoma and venous tumor thrombus: an effective preoperative adjuvant therapy for patients with advanced tumor thrombus. Eur Urol Suppl. 2014;13:e938.

    Article  Google Scholar 

  27. Romero FR, Muntener M, Herman S. Bagga, et al. Pure laparoscopic radical nephrectomy with level II vena caval thrombectomy. Urology. 2006;68(5):1112–4, ISSN 0090-4295. https://doi.org/10.1016/j.urology.2006.08.1084.

    Article  PubMed  Google Scholar 

  28. Chopra S, Simone G, Metcalfe C, de Castro Abreu AL, Nabhani J, Ferriero M, et al. Robot-assisted level II–III inferior vena cava tumor thrombectomy: step-by-step technique and 1-year outcomes. Eur Urol. 2017;72(2):267–74, ISSN 0302-2838. https://doi.org/10.1016/j.eururo.2016.08.066.

    Article  PubMed  Google Scholar 

  29. Klink JC, Westesson KE, Gao T, Stephenson AJ, Krishnamurthi V. Tumor thrombus transection in renal cell carcinoma. J Clin Oncol. 2013;31:4090. https://doi.org/10.1200/jco.2013.31.6_suppl.409.

    Article  Google Scholar 

  30. Kundavaram C, Abreu AL, Chopra S, et al. Advances in robotic vena cava tumor thrombectomy: intracaval balloon occlusion, patch grafting, and vena cavoscopy. Eur Urol. 2016;70(5):884–90. https://doi.org/10.1016/j.eururo.2016.06.024.

    Article  PubMed  Google Scholar 

  31. Alahmari A, Alzahrani Z, Algarni KS, et al. Robotic inferior vena cava thrombectomy using a novel intracaval balloon occlusion technique. Cent European J Urol. 2020;73:106–7.

    PubMed  PubMed Central  Google Scholar 

  32. Gill IS, Metcalfe C, Abreu A, Duddalwar V, Chopra S, Cunningham M, et al. Robotic level III inferior vena cava tumor thrombectomy: initial series. J Urol. 2015;194(4):929–38. https://doi.org/10.1016/j.juro.2015.03.119.

    Article  PubMed  Google Scholar 

  33. Martínez-Salamanca JI, Huang WC, Millán I, Bertini R, Bianco FJ, Carballido JA, et al. Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension. Eur Urol. 2011;59(1):120–7. https://doi.org/10.1016/j.eururo.2010.10.001.

    Article  PubMed  Google Scholar 

  34. Wang B, Li H, Ma X, Zhang X, Gu L, Li X, et al. Robot-assisted laparoscopic inferior vena cava thrombectomy: different sides require different techniques. Eur Urol. 2016;69:1112–9.

    Article  Google Scholar 

  35. Wang B, Li H, Huang Q, Liu K, Fan Y, Peng C, et al. Robot-assisted retrohepatic inferior vena cava thrombectomy: first or second Porta Hepatis as an important boundary landmark. Eur Urol. 2018 Oct;74(4):512–20. https://doi.org/10.1016/j.eururo.2017.11.017.

  36. Van Rees VS, de la Rosette J. The CROES data management system: a glimpse behind the scenes. J Endourol. 2011;25(1):1–5. https://doi.org/10.1089/end.2010.1557.

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Correspondence to Agustin Romeo.

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Alberto Jurado, Agustin Romeo, Guillermo Gueglio, and Patricio Garcia Marchiñena each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Jurado, A., Romeo, A., Gueglio, G. et al. Current Trends in Management of Renal Cell Carcinoma with Venous Thrombus Extension. Curr Urol Rep 22, 23 (2021). https://doi.org/10.1007/s11934-021-01036-y

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