Modified vein clamping technique for renal cell carcinoma complicated with level I–II IVC thrombi: a study at a single centre

Abstract Objectives To share our initial experience with the modified vein clamping technique for the treatment of renal cell carcinoma complicated with level I–II IVC thrombi. Methods From March 2018 to April 2021, 11 patients with renal cell carcinoma (RCC) involving an IVC tumour thrombus were admitted to our hospital. They all underwent laparoscopic radical nephrectomy and IVC thrombectomy (LRN-IVCTE) using a modified vein clamping technique. Results All procedures were successfully completed without conversion to open surgery. The median operative time was 185.00 min (145.00–216.00 min); the median estimated blood loss was 200.00 ml (155.00–300.00 ml), and four patients received an intraoperative transfusion. In addition, the median IVC clamping time was 18.00 min (12.00–20.00 min); the median postoperative hospital stay was 6.00 days (4.00–7.00 days), while the median follow-up period was 28.00 months (4.00–34.00 months). Conclusions The modified vein clamping technique for the treatment of renal cell carcinoma complicated with level I–II IVC thrombi may be a safe and technically feasible alternative technique.

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Modified Vein Clamping Technique for Renal Cell Carcinoma Complicated With Level I-II IVC Thrombus: A Study At A Single Center

10.21203/rs.3.rs-855915/v1 ◽

2021 ◽

Author(s):

Jiaxing Ma ◽

Wei Sun ◽

Weiwei Qian ◽

Jie Min ◽

Tao Zhang ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Conversion To Open Surgery ◽

Estimated Blood Loss ◽

Ivc Thrombus ◽

Feasible Alternative ◽

Level I ◽

Ivc Tumor

Abstract Objectives To share our initial experience with modified vein clamping technique for the treatment of renal cell carcinoma complicated with the level I-II IVC thrombus Methods From March 2018 to April 2021, 11 patients with renal cell carcinoma (RCC) involving the IVC tumor thrombus were admitted to our hospital. Then, they all underwent laparoscopic radical nephrectomy and IVC thrombectomy (LRN-IVCTE) using modified vein clamping technique. Results All procedures were successfully completed without conversion to open surgery. The median operative time was 185 min (range 125–229 min); the median estimated blood loss was 200 ml (range 150–300 ml), and four patients received an intraoperative transfusion. Besides, the median IVC clamping time was 18 min (range 10–24 min); the median postoperative hospital stay was 6 days (range 4–8 days), while the median follow-up period was 28 months (range 2–36 months). Conclusions Modified vein clamping technique for the treatment of renal cell carcinoma complicated with the level I-II IVC thrombus may be a safe and technically feasible alternative technic.

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Perioperative and oncological outcomes of renal cell carcinoma with venous tumour thrombus

Urologia Journal ◽

10.1177/03915603211007030 ◽

2021 ◽

pp. 039156032110070

Author(s):

Sriharsha Bokka ◽

Ramanitharan Manikandan ◽

Lalgudi Narayanan Dorairajan ◽

K Srivathsa ◽

Kodakkattil Sreenivasan Sreerag ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Blood Loss ◽

Hospital Stay ◽

Cell Carcinoma ◽

Surgical Outcomes ◽

Renal Cell ◽

Operative Time ◽

Survival Rates ◽

Tumour Thrombus

Aim: The aim of the present study is to report the perioperative and long-term surgical outcomes of renal cell carcinoma (RCC) with venous tumour thrombus (VTT). Materials and methods: Data of 34 patients (males = 23, females = 11) from 2009 to 2020 who underwent radical nephrectomy with thrombectomy for RCC and VTT was retrospectively analysed. The parameters recorded include tumour laterality, size, level of thrombus, surgical approach, blood loss, transfusion rates, operative time, hospital stay, Clavien complications, tumour histology, follow-up duration, local recurrence, distant metastasis, overall and cancer-specific survival rates. Results: The extent of thrombus was level I in thirteen, level II in twelve, level III (a-1, b-2, c-1, d-2) in six and level IV in three patients respectively. Mean operative time was 320 (±145) min, mean blood loss was 1371.15 (±1020.8) ml and mean hospital stay was 9.6 (±7.4) days. Mean transfusion rate was 6.4 (±3.2) units. Three patients died within the first 30 days of surgery. Cardiopulmonary bypass (CPB) was utilized in three patients. Median follow-up period was 58 (Range: 4–101) months. A statistically significant correlation was found between operative time ( p = 0.014) and median survival ( p = 0.003) respectively and tumour thrombosis level. Nine patients died due to metastasis, and ten due to unrelated causes. The estimated actuarial survival rates at a median of 58 months were 35.3%. Conclusion: An accurate preoperative assessment of the thrombus extent with the involvement of a multidisciplinary team approach is crucial in achieving optimal surgical outcomes in patients of RCC with VTT, particularly with level III and IV thrombus.

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Renal Cell Carcinoma with or without Tumor Thrombus Invading the Liver, Pancreas and Duodenum

Cancers ◽

10.3390/cancers13071695 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1695

Author(s):

Javier González ◽

Jeffrey J. Gaynor ◽

Gaetano Ciancio

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Tumor Thrombus ◽

Locally Advanced ◽

Vena Cava ◽

Complication Rates ◽

Durable Response ◽

Estimated Blood Loss ◽

Level I

Background: The purpose of this study is to report the outcomes of a series of patients with locally advanced renal cell carcinoma (RCC) who underwent radical nephrectomy, tumor thrombectomy, and visceral resection. Patients and methods: 18 consecutive patients who underwent surgical treatment in the period 2003-2019 were included. Neoplastic extension was found extending into the pancreas, duodenum, and liver in 9(50%), 2(11.1%), and 7(38.8%) patients, respectively. Seven patients (38.8%) presented also inferior vena cava tumor thrombus level I (n = 3), II (n = 2), or III (n = 2). The resection was tailored according to the degree of invasiveness. Demographics, clinical presentation, disease characteristics, surgical details, 30-day postoperative complications, and overall survival (OS) were analyzed. Results: Median age was 56 years (range: 40–76). Median tumor size was 14.5 cm (range, 8.8–22), and 10 cm (range: 4–15) for those cases with pancreatico-duodenal and liver involvement, respectively. Median estimated blood loss (EBL) was 475 mL (range: 100–4000) and resulted higher for those cases requiring thrombectomy (300 mL vs. 750 mL). Nine patients (50%) required transfusions with a median requirement of 4 units (range: 2–8). No perioperative deaths were registered in the first 30 days. Overall complication rate was 44.4%. Major complications were detected in 6/18 patients (33.3%). Overall median follow-up was 24 months (range: 0–108). Five-year OS (actuarial) rate was 89.9% and 75%, for 9/11 patients with pancreatico-duodenal involvement and 6/7 patients with liver invasion, respectively. Conclusion: Our series establishes the technical feasibility of this procedure with acceptable complication rates, no deaths, and potential for durable response.

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506: A Risk-Adjusted Follow-up for Patients with Stage I and II Renal Cell Carcinoma

The Journal of Urology ◽

10.1016/s0022-5347(18)30746-8 ◽

2007 ◽

Vol 177 (4S) ◽

pp. 169-169

Author(s):

Quoc-Dien Trinh ◽

Pierre I. Karakiewicz ◽

Thierry Lebeau ◽

Dan Lewinshtein ◽

Elie Antebi ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Stage I

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Identification of miR-20a-5p as Robust Normalizer for Urine microRNA Studies in Renal Cell Carcinoma and A Profile of Dysregulated microRNAs

International Journal of Molecular Sciences ◽

10.3390/ijms22157913 ◽

2021 ◽

Vol 22 (15) ◽

pp. 7913

Author(s):

Julia Oto ◽

Raquel Herranz ◽

Emma Plana ◽

José Vicente Sánchez-González ◽

Javier Pérez-Ardavín ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Diagnostic Value ◽

Diagnostic Model ◽

Low Grade ◽

Non Invasive ◽

Good Expression ◽

Independent Cohort

Renal cell carcinoma (RCC) is the third most frequent urinary malignancy and one of the most lethal. Current diagnostic and follow-up techniques are harmful and unspecific in low-grade tumors. Novel minimally invasive markers such as urine microRNAs (miRNAs) are under study. However, discrepancies arise among studies in part due to lack of consent regarding normalization. We aimed to identify the best miRNA normalizer for RCC studies performed in urine samples together with a miRNA profile with diagnostic value and another for follow-up. We evaluated the performance of 120 candidate miRNAs in the urine of 16 RCC patients and 16 healthy controls by RT-qPCR followed by a stability analysis with RefFinder. In this screening stage, miR-20a-5p arose as the most stably expressed miRNA in RCC and controls, with a good expression level. Its stability was validated in an independent cohort of 51 RCC patients and 32 controls. Using miR-20a-5p as normalizer, we adjusted and validated a diagnostic model for RCC with three miRNAs (miR-200a-3p, miR-34a-5p and miR-365a-3p) (AUC = 0.65; Confidence Interval 95% [0.51, 0.79], p = 0.043). let-7d-5p and miR-205-5p were also upregulated in patients compared to controls. Comparing RCC samples before surgery and fourteen weeks after, we identified let-7d-5p, miR-152-3p, miR-30c-5p, miR-362-3p and miR-30e-3p as potential follow-up profile for RCC. We identified validated targets of most miRNAs in the renal cell carcinoma pathway. This is the first study that identifies a robust normalizer for urine RCC miRNA studies, miR-20a-5p, which may allow the comparison of future studies among laboratories. Once confirmed in a larger independent cohort, the miRNAs profiles identified may improve the non-invasive diagnosis and follow-up of RCC.

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