MP64-07 CORRELATION OF RENAL VEIN INVASION AND IVC INVASION IN RCC WITH CAVAL THROMBUS

Abstract

You have accessJournal of UrologyKidney Cancer: Localized V1 Apr 2014MP64-07 CORRELATION OF RENAL VEIN INVASION AND IVC INVASION IN RCC WITH CAVAL THROMBUS Karin Westesson, Christopher Przybycin, and Venkatesh Krishnamurthi Karin WestessonKarin Westesson More articles by this author , Christopher PrzybycinChristopher Przybycin More articles by this author , and Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1924AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Tumor extension into the inferior vena cava (IVC) occurs in 5% of renal cell carcinoma (RCC) cases. Invasion into the venous endothelium is not discernible prior to surgery. If present, it poses a surgical challenge and carries a worse prognosis. If IVC endothelium invasion were identifiable preoperatively, alternative techniques, such as IVC resection, could be employed to render patients disease free. We hypothesized that depth of invasion into the renal vein (RV) wall is predictive for IVC endothelium invasion. The objective of this study was to determine the correlation between renal vein invasion and IVC invasion. METHODS Following IRB approval we reviewed 26 cases of nephrectomy and IVC thrombectomy performed between 2010 and 2012. Clinical data was obtained from a database of patients with IVC tumors. Operative notes were reviewed to determine intraoperative assessment of tumor thrombus adherence to the IVC endothelium and cases were categorized as adherent (AD) or non-adherent (NA). Tissue sections containing tumor within the RV and IVC were reviewed to determine invasion into the venous intima and/or muscularis. Clinical assessment of adherence and histopathological findings were analyzed with Fishers’ Exact test. RESULTS Mean patient age was 63 years and 65% of patients were men. IVC thrombus extension was level II, III and IV in 7 (27%), 7 (27%) and 12 (46%) cases, respectively. RCC subtype was clear cell in 18, papillary in 5 and unclassified in 3. Of the 26 cases, 7 (27%) were identified as AD and 19 (73%) were NA. Histopathological results are noted in Table 1. Of the 7 AD tumors, 6 had IVC sections for examination. Of the 19 NA tumors, 3 tumors (25%) were non-adherent and were removed without adjacent IVC; therefore 12 had sections of IVC with tumor for examination. There was no significant correlation between RV muscularis invasion and clinical adherence to the IVC endothelium (P=0.461) CONCLUSIONS Intraoperative impression of IVC adherence is supported by histopathological findings of IVC muscularis invasion in 50% of cases. Depth of invasion at the RV margin does not correlate with the intraoperative assessment of IVC adherence and histopathological findings of IVC endothelial invasion. Tumor invasion at the RV margin is presently not a useful intraoperative parameter to facilitate complete resection of IVC tumor thrombi. Table 1: Clinical adherence versus depth of invasion Group Depth of Invasion IVC intima IVC muscularis RV intima RV muscularis AD (N=7) 6 (100%)∗ 3 (50%)∗ 5 (71%) 2 (29%) NA (N=19) 9 (75%) 1 (8%) 17 (89%) 7 (37%) ∗IVC sections with tumor were only available in 6 of the 7 sticky tumor cases © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e703 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Karin Westesson More articles by this author Christopher Przybycin More articles by this author Venkatesh Krishnamurthi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...