Surgical treatment of intracaval tumor relapse after radical tumor nephrectomy in locally advanced renal cell carcinoma

Abstract

About 4-10% of patients with renal cell carcinoma (RCC) demonstrate intracaval tumor thrombi at the time of diagnosis. Furthermore, 2-3% of patients might develop local relapses of which intracaval recurrences represent arare event with fewer than 15cases reported in the literature. We report the diagnosis, surgical technique, perioperative complications, and oncological outcome in an additional 6cases. Between 2008 and 2019, 6patients were treated with isolated intracaval relapse of RCC. All patients had undergone radical nephrectomy with thrombectomy in the past. The mean time between first surgery and relapse was 45.2 (6-114) months and the mean age of patients was 75 (70-80)years: 2, 3and 1patient demonstrated thrombus levelII, III, and IV, respectively. Athoracoabdominal and atransperitoneal surgical approach was chosen in 4and 2patients, respectively. Perioperative complications were reported according to the Clavien-Dindo classification. Relapse-free, cancer-specific and overall survival were calculated with the Kaplan-Meier method. The cava thrombus could be resected completely in all cases. The mean time of surgery was 330 (260-510) min and the mean blood loss was 1500 (300-6500) ml. Clavien-Dindo gradeII andIV complications developed in 2and 1patients, respectively. The 90-day readmission rate and mortality were 0%. After amean follow-up of 32.3 (6-96)months, 5patients are relapse-free and 1patient developed pulmonary and hepatic metastases managed by immuno-oncological therapy. One patient died 27months postoperatively due to multiple myeloma. Secondary thrombectomy for isolated intracaval tumor thrombus relapse represents achallenging surgery which is associated with ahigh oncological control rate and tolerable surgery-related morbidity. This type of surgery should be performed in centres with significant expertise in radical nephrectomy for locally advanced disease and thrombus surgery.