MP75-14 ROLE OF NEPHRON-SPARING SURGERY FOR RENAL CELL CARCINOMA IN THE SETTING OF VENOUS TUMOR THROMBUS

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V1 Apr 2016MP75-14 ROLE OF NEPHRON-SPARING SURGERY FOR RENAL CELL CARCINOMA IN THE SETTING OF VENOUS TUMOR THROMBUS Firas Petros, Debra Zynger, Ahmad Shabsigh, David Sharp, and Geoffrey Box Firas PetrosFiras Petros More articles by this author , Debra ZyngerDebra Zynger More articles by this author , Ahmad ShabsighAhmad Shabsigh More articles by this author , David SharpDavid Sharp More articles by this author , and Geoffrey BoxGeoffrey Box More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1732AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nephron-Sparing Surgery (NSS) is a standard treatment option for renal tumors. With growing experience, larger more complex tumors are being treated with NSS, both open and robot-assisted partial nephrectomy (RAPN). We describe our experience with patients undergoing NSS in the setting of venous tumor thrombosis (VTT). METHODS Patients with renal cell carcinoma (RCC) who had undergone NSS at our institution from January 1, 2009 to October 31, 2014 and were found to have VTT were retrospectively reviewed. Patient characteristics and outcomes were reported. RESULTS A total of 708 patients underwent NSS, 43 of which (6.1%) were found to have pT3a RCC on final pathology, 14 (2%) had VVT, including vein only involvement in 11 (1.6%) and vein with fat involvement in 3 (0.4%) patients. Mean tumor nephrometry score was 9.4 (range 6-11) with a mean pathologic tumor size of 6.0 cm (range 3-9). Ten (71%) patients had VTT discovered incidentally at time of surgery. Of the 14 pT3a patients, 9 had RAPN with removal of VTT, 4 had open NSS with excision of VTT, and 1 patient was converted to radical nephrectomy. Clavien III and IV complications occurred in 2 patients. Mean follow-up was 21 months (range 1-45). There were 2 patients who developed local recurrences at one year follow-up. There were 2 deaths from metastatic disease at a median of 20 months post-surgery, both of these patients had clear cell RCC with sarcomatoid differentiation. CONCLUSIONS VTT is infrequently encountered during NSS but may be successfully removed at the time of surgery. In this series of patients, VTT, when present, was usually discovered incidentally at time of surgery. Surgeons need to be aware of this potential and should have a plan to manage it. It is imperative to keep oncologic principles in mind and conversion to open and /or radical nephrectomy may be prudent in certain cases. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e984 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Firas Petros More articles by this author Debra Zynger More articles by this author Ahmad Shabsigh More articles by this author David Sharp More articles by this author Geoffrey Box More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...