Outcomes in Renal Cell Carcinoma with Inferior Vena Cava Thrombus Treated with Surgery.

Abstract

Introduction. Renal cell carcinoma can invade through the renal vein into the inferior vena cava, and can extend intraluminally, with tumor-thrombus formation. Methods: Retrospective study from January 2003 to August 2016. Surgical outcomes were analyzed. Neves classification was used for patient categorization. Kaplan Meier and Log-Rank test were used for survival analysis. Results: A total of 134 patients were included, 69 males (51.4%) and 65 females (49%), M:F ratio 1.06:1. Tumor size, bleeding and surgical time were higher in level IV thrombi (mean 16.1cm, 3 064ml and 6.5hrs, respectively), compared to level I (8.5cm, 1033ml and 3.1hrs, respectively). A higher frequency of positive lymph nodes was observed in levels III and IV compared with levels I and II (49% vs. 17.7%, p=0.0001). Distant metastases were observed in 36 pts. (27%). Overall surgical mortality was 4.5%. 5-year overall survival was 63%. We observed a 5-year survival in patients with level I-II 82% and level III and IV 46%. Conclusions: Our results suggest the benefit for the patient of an aggressive surgical approach with an acceptable mortality and 5-year survival rate. The results obtained justify an aggressive surgical approach to these tumors.