Renal cell carcinoma with IVC tumour thrombus: A study of clinico-pathological outcomes

Abstract

To evaluate the experience of RCC with IVC thrombus in terms of impact of clinical and pathological factors, level of thrombus and complications on outcome of the disease . Seventeen patients underwent radical nephrectomy and IVC tumour thrombectomy during 2012 to 2015 at our tertiary health care centre, clinico -pathological data from these patients were retrospectively analysed. Of the 17 patients (male: female: 3:1), the mean age was 57 years. The tumour thrombus extension was level I in 58%, level II in 29%, level III in 11%. In our series, the mean blood loss in levels I – III tumour thrombus were1863 mL, 3380 mL, 3250 ml respectively.Clavien dindo complications were -grade I in 1 case, grade II in 7 cases, grade III in 2 cases, grade IV in 3 cases. Pathological examination demonstrated that 13 out of 17 patients had clear cell carcinoma, five patients had higher grade(3, 4)and three had perinephric and IVC wall invasion. There was no perioperative hospital mortality. Two patients were lost to followup, one patient died due to extensive metastatic disease after 4 year, all other are under regular followup. Radical nephrectomy with IVC thrombectomy remains a challenging procedure. Multiple histopathological variables especially tumour stage and grade have a strong impact on the morbidity and mortality and also help in stratifying the subgroup in which adjuvant therapy is essential. With detailed perioperative planning and multidisciplinary efforts, surgical resection is the definitive treatment of choice for patients of RCC with IVC tumour thrombus.