Surgical Treatment Of Renal Cell Carcinoma Research Articles

Neoadjuvant stereotactic ablative body radiotherapy combined with surgical treatment for renal cell carcinoma and inferior vena cava tumor thrombus: a prospective pilot study.

Surgical treatment for renal cell carcinoma (RCC) and inferior vena cava (IVC) tumor thrombus (TT) is difficult, and the postoperative complication rate is high. This study aimed to explore the safety and oncologic outcomes of neoadjuvant stereotactic ablative body radiotherapy (SABR) combined with surgical treatment for RCC and IVC-TT. Patients with RCC and IVC-TTs were enrolled in this study. All patients received neoadjuvant SABR focused on the IVC at a dose of 30Gy in 5 fractions, followed by 2 ~ 4 weeks of rest. Then, radical nephrectomy and IVC tumor thrombectomy were performed for each patient. Adverse effects, perioperative outcomes, and long-term prognoses were recorded. From June 2018 to January 2019, 8 patients were enrolled-4 with Mayo grade II TT and 4 with Mayo grade III TT. Four (50%) patients had complicated IVC wall invasion according to CT/MRI. All patients received neoadjuvant SABR as planned. Short-term local control was observed in all 8 patients. Only Grade 1-2 adverse events were reported. In total, 3 (37.5%) laparoscopic surgeries and 5 (62.5%) open surgeries were performed. The median operation time was 359 (IQR: 279-446) min, with a median intraoperative bleeding volume of 750 (IQR: 275-2175) ml. The median postoperative hospital stay was 7 (5-10) days. With a 26-month (range: 5-41) follow-up period, the estimated mean overall survival was 30.67 ± 5.38 months. This is the first preoperative radiotherapy study in Asia that focused on patients with TT. This study revealed the considerable safety of neoadjuvant SABR for RCC with IVC-TT. This study was registered in the Chinese Clinical Trials Registry on 2018-03-08 (ChiCTR1800015118). For more information, please see the direct link ( https://www.chictr.org.cn/showproj.html?proj=25747 ).

The surgical evolution of radical nephrectomy and tumor thrombectomy: a narrative review.

Renal cell carcinoma (RCC) accounts for 2-3% of all malignant disease in adults. RCC propagates into the renal vein and inferior vena cava (IVC) in up to 25% of patients with RCC. Despite advances in medical management such as immunotherapy, surgical resection remains the gold standard treatment of RCC with venous tumor thrombus (TT) extension. Surgical innovation has revolutionized the management of RCC with TT, reducing morbidity and mortality through advanced surgical techniques and minimally invasive approaches. The aim of this review is to summarize the evolving developments in the surgical treatment of RCC with venous TT. We performed an advanced search on PubMed between the inception of the database and April 2022 to summarize the evolution of the surgical management of RCC with venous TT, focusing on the reports of key historical, current, and recent studies. Implementation of entirely intraabdominal liver transplant-based approaches have allowed for successful surgical excision of higher-level tumor thrombi, obviating the need for sternotomy or cardiopulmonary bypass (CPB). Recent advances in robotic surgery provide a promising approach for minimally invasive management of RCC with venous TT extension. Surgical innovation has revolutionized the management of RCC with TT, reducing morbidity and mortality through minimally invasive techniques with preserved oncologic effectiveness.

The use of Doppler vascular resistance in the early diagnosis of chronic kidney disease progression in patients with renal cell carcinoma

Development and progression of chronic kidney disease (CKD) in patients with renal cell carcinoma (RCC) after radical nephrectomy remains an extremely pressing contemporary issue.
 Postoperative changes of the ultrasound resistance index (RI) in the contralateral kidney not affected by the tumor after surgical treatment of RCC, as well as correlations between changes in IR and in glomerular filtration rate (GFR) remain far from being comprehensively investigated.
 The RI changes in the parenchyma of the intact (unaffected by the tumor) kidney before and after surgical treatment for RCC, and establishing correlations between RI changes and creatinine-dependent GFR remain unexplored issues.
 Objective. To assess the correlation between RI and GFR in the kidney not affected by the RCC before and after radical nephrectomy.
 Materials and methods. The study enrolled 49 patients. Group I included 37 patients with an initial diagnosis of RCC (on the right), Stage III of the disease, and without signs of chronic renal failure (GFR was ≥ 90 ml/min/1.73 m2).
 In patients with RCC, six months after surgery, the RI increase in the contralateral kidney unaffected by the tumor was significantly associated with a significant reduction in GFR. Thus, RI can be potentially used to predict the development of CKD in this patient population.

EARLY AND LATE POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH LOCALIZED AND LOCALLY ADVANCED RENAL CELL CARCINOMA

Background: Modern Russian statistics show that the percentage of renal cell carcinoma (RCC) among all oncological diseases has increased and amounted to almost 5% in 2019. The main method of treating RCC is radical nephrectomy in localized RCC, which is supplemented by the removal of regional lymph nodes in locally advanced RCC. Aim: To evaluate early and late postoperative complications in patients with localized and locally advanced renal cell carcinoma. Methods: We’ve analyzed the results of surgical treatment and postoperative complications in 378 patients with clinically proven localized and locally developed RCC. Results: The total number of complications after surgical treatment of patients with localized and locally advanced RCC was 24 (6.3%) patients. Moreover, in the treatment of the localized form of RCC, postoperative complications are 3 times less common than in the locally advanced form of RCC (p <0.05). The most common complication after surgical treatment of RCC was bleeding which we observed in 11(2.9%) patients. Conclusion: After surgical treatment of RCC, the proportion of complications is not high, but they can have unpleasant consequences. In the late postoperative period the most common complication bleeding is followed by lymphorrhea and urinary tract infections.

Abstract 2191: Clear cell renal cell carcinoma molecular differences between Hispanic Americans and European Americans

Abstract Background: Hispanic Americans (HAs) in Arizona have a heavy burden of renal cell carcinoma (RCC) presenting at a younger age at diagnosis with higher incidence and mortality rates than European Americans (EAs). However, HAs are underrepresented in RCC research, and tumor molecular characteristics in this population are unknown. We report preliminary findings from a study of molecular differences between HAs and EAs exploring the molecular basis of early-onset clear cell RCC (ccRCC). Methods: Clinical records of patients who underwent surgical treatment for RCC between 2011 and 2020 at the University of Arizona Department of Urology was reviewed. A total of 539 patients were identified, and paraffin embedded surgical specimens of a subset of patients with ccRCC were selected for this study. Three exons of VHL gene, the most commonly altered gene in ccRCC, were screened for somatic mutations in a total of 117 patients. Thirty-three patients were included for TempO-Seq analysis to correlate molecular subtype with demographic and clinicopathologic characteristics. Results: Among 117 patients, 55 somatic mutations in coding regions of VHL were found in 42 patients (35.9%). Nine patients had more than 2 somatic mutations. There were 37 substitutions, 14 deletions, and 4 insertions. There was one patient with a mutation of an intron variant that was a splice acceptor. Mutations in the coding regions were more common in EAs (40.9%) than HAs (31%), but the difference was not statistically significant (P=0.32). For moderate or high impact mutations, EAs had mutations at a significantly higher frequency than HAs (39.4% vs. 20.5%, P=0.04). Patients with high impact mutations tend to be diagnosed before the age of 50 (37.5%) compared to patients without high impact mutations (23.9%). We were able to assign 32 out of 33 patients into molecular subtypes (ccA and ccB). Molecular subtype could not be assigned to one HA patient with high grade and advanced stage ccRCC. Compared to patients with ccB subtype, patients who had ccA subtype were younger (mean age of 52.2 vs. 61.4) and tend to be obese (55.6% vs. 28.6% body mass index ≥30). Molecular subtype, ccA, was more common in HAs than EAs (64.3% vs. 41.2%), but this difference was not statistically significant. Conclusion: Somatic mutations within the VHL gene often altered in early during ccRCC pathogenesis were less common in HAs, but ccA associated with early age of diagnosis and obesity was more common in HAs. Impact: HAs and EAs have different molecular basis of early-onset ccRCC which may impact clinical managements. Citation Format: Yuliang Chen, Karleen M. Meiklejohn, Nathan Ellis, Erika R. Bracamonte, Benjamin R. Lee, Ken Batai. Clear cell renal cell carcinoma molecular differences between Hispanic Americans and European Americans [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2191.

Progress in survival in renal cell carcinoma through 50 years evaluated in Finland and Sweden.

Global survival studies have shown favorable development in renal cell carcinoma (RCC) treatment but few studies have considered extended periods or covered populations for which medical care is essentially free of charge. We analyzed RCC survival in Finland and Sweden over a 50-year period (1967-2016) using data from the NORDCAN database provided by the local cancer registries. While the health care systems are largely similar in the two countries, the economic resources have been stronger in Sweden. In addition to the standard 1- and 5-year relative survival rates, we calculated the difference between these as a measure of how well survival was maintained between years 1 and 5. Relative 1- year survival rates increased almost linearly in both countries and reached 90% in Sweden and 80% in Finland. Although 5-year survival also developed favorably the difference between 1- and 5-year survival rates did not improve in Sweden suggesting that the gains in 5-year survival were entirely due to gains in 1-year survival. In Finland there was a gain in survival between years 1 and 5, but the gain in 1-years survival was the main contributor to the favorable 5-year survival. Age group specific analysis showed large survival differences, particularly among women. Towards the end of the follow-up period the differences narrowed but the disadvantage of the old patients remained in 5-year survival. The limitations of the study were lack of information on performed treatment and clinical stage in the NORDCAN database. In conclusion, the available data suggest that earlier diagnosis and surgical treatment of RCC have been the main driver of the favorable change in survival during the past 50 years. The main challenges are to reduce the age-specific survival gaps, particularly among women, and push survival gains past year 1.

Surgical management of renal cell carcinoma with levels III and IV tumor thrombus using the «flush» technique.

To determinate feasibility and results of the flush technique by hands for the surgical management of renal cell carcinoma (RCC) with levels III and IV inferior vena cava thrombus (VCT). We conducted a retrospective study for all patients who underwent a surgical treatment for RCC with levels III and IV VCT in our department between June 2010 and July 2017. Sixteen patients were identified. All tumors were resected using a subcostal incision for right RCC and a chevron incision for the left RCC. Vena cava control was performed only on its subhepatic portion. After renal artery ligature, anesthesiologists were asked to generate a positive pressure in the small circulation. Subsequently, the vena cava was incised longitudinally to the orifice of the renal vein and the thrombus dissected and extracted of the upper part of the vena cava. Only once the supra-renal part of the vena cava was free of thrombus, the supra-renal portion of the vena cava could be clamped. We never had to perform neither thoracotomy nor hepatic mobilization. Therefore, support of a hepatic, vascular or cardiac surgeon was not necessary. The mean operative time was 201min. The mean estimated blood loss was 2040ml. No patient died during hospitalization, and mean hospitalization stay duration was 16.6days. The flush technique allows a limitation of the dissection extent. It requires neither hepatic mobilization nor thoracotomy. This results in a decrease in the operative time and blood loss.

Surgical treatment of renal-cell carcinoma in elderly people

ObjectiveTo describe the oncological characteristics and evolution of patients 65 years or older who underwent surgery for renal-cell carcinoma (RCC). MethodsWe reviewed our prospectively maintained database of patients with RCC treated surgically. Those ≥65 years old were selected. We analyzed clinical and pathological characteristics as well as oncological and functional outcomes. Overall survival (OS) was estimated with the Kaplan–Meier method. Multivariate Cox-proportional hazards model was used to determine predictors of OS. ResultsA total of 156 elderly patients with mean age 72.0±5.5 years (range 65–92) and median follow-up of 33 months were included. Surgical approach was open radical nephrectomy in 114 (73.5%), laparoscopic radical nephrectomy in 13 (8.4%), open partial nephrectomy in 23 (14.2%) and laparoscopic partial nephrectomy in 6 (3.9%). Pathological stage was: Stage I, 71 (45.5%); Stage II, 27 (17.3%); Stage III, 48 (30.8%); and Stage IV, 10 (6.4%). Lastly, 51 (32.6%) patients died, 22 (43.1%) from cancer. The 5-year OS according to pathological stage was 77.6%, 71.9%, 45.1% and 11.7% for stage I, II, III and IV, respectively (p<.001). On multivariate analysis, pathological stage independently predicted OS (HR 1.96, 95% CI [1.36–2.84], p=.0003). ConclusionsThe surgical management of RCC appears to be safe in properly selected patients 65 years or older. Pathological stage predicts survival in this population.

MP44-20 CAN MORPHOLOGIC FEATURES OF VENA CAVAL TUMOR THROMBUS ON CT OR MRI BE A PROGNOSTIC FACTOR AFTER SURGICAL TREATMENT OF RENAL CELL CARCINOMA WITH IVC THROMBUS?

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging II1 Apr 2015MP44-20 CAN MORPHOLOGIC FEATURES OF VENA CAVAL TUMOR THROMBUS ON CT OR MRI BE A PROGNOSTIC FACTOR AFTER SURGICAL TREATMENT OF RENAL CELL CARCINOMA WITH IVC THROMBUS? Don kyoung Choi, Hwang Gyun Jeon, Byong Chang Jeong, Seong Soo Jeon, Hyun Moo Lee, Han-Yong Choi, Chang Wook Jeong, Cheol Kwak, Cheryn Song, Jinsoo Chung, Sung Kyu Hong, Sung-Hoo Hong, and Seong Il Seo Don kyoung ChoiDon kyoung Choi More articles by this author , Hwang Gyun JeonHwang Gyun Jeon More articles by this author , Byong Chang JeongByong Chang Jeong More articles by this author , Seong Soo JeonSeong Soo Jeon More articles by this author , Hyun Moo LeeHyun Moo Lee More articles by this author , Han-Yong ChoiHan-Yong Choi More articles by this author , Chang Wook JeongChang Wook Jeong More articles by this author , Cheol KwakCheol Kwak More articles by this author , Cheryn SongCheryn Song More articles by this author , Jinsoo ChungJinsoo Chung More articles by this author , Sung Kyu HongSung Kyu Hong More articles by this author , Sung-Hoo HongSung-Hoo Hong More articles by this author , and Seong Il SeoSeong Il Seo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1562AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although various prognostic factors have been studied for renal cell carcinoma (RCC) with IVC thrombus, the prognostic value of thrombus feature in these patients remains unclear. To analyze the effect of morphologic feature of IVC thrombus on overall survival (OS) and cancer-specific survival (CSS) after surgery. METHODS We retrospectively analyzed the records of 169 patients of RCC with IVC thrombus who underwent radical nephrectomy and thrombectomy from 1998 to 2013 at 5 centers. IVC thrombi were classified as spherical(smooth surfaced, type I) and spiculated (type II) according to their morphologic features on CT or MRI. The classification was carried out by 1 radiologist and 2 urologists in a blind fashion (without prior knowledge of patient characteristics). Multivariate ordered Cox regression models were used to quantify the impact of various prognostic factors on OS and CSS. RESULTS Type 1 was found in 30 patients (17.8%) and type 2 in 139 patients (82.2%). Mean follow-up was 38.0 months (IQR: 12-57). Demographic characteristics were not significantly different between type I and type II except for the cranial thrombus level (p=0.004). 5-yr OS was 77.4% in patients with type I and 33.0% in patients with type II. In cases of pN0/XM0, 22 (21.6%) had type 1, and 80 (78.4%) had type 2. On multivariate analysis, distant metastasis, thrombus morphology, and remnant venous thrombus significantly affected OS in pNanyMany patients (all p<0.05). Among the pN0/XM0 patients, thrombus morphology (p=0.016) significantly affected OS. In terms of CSS, ECOG performance score (p=0.034), distant metastasis, Furhman grade and thrombus morphology significantly affected CSS in pNanyMany patients (all p<0.05). In patients with pN0/XM0, only thrombus morphology (p=0.031) significantly affected CSS. CONCLUSIONS Thrombus morphology is an independent predictor of OS and CSS after surgical treatment of RCC with IVC thrombus. Furthermore, remnant venous thrombus also appears to be an independent predictor of OS. Multivariable Cox regression analysis predicting overall survival (any N any M) Variables Univariable Multivariable HR (95% CI) p-value Age 0.248 0.992 (0.972-1.012) 0.431 ECOG PS (0-1 vs 2-3) 0.023 1.786 (0.869-3.668) 0.115 Thrombus level (I-II-III vs. IV) 0.400 1.134 (0.533-2.412) 0.745 Distant metastasis <0.001 2.227 (1.426-3.478) <0.001 LN involvement (N0/X vs. N1) 0.090 1.224 (0.816-2.853) 0.185 Furhmann grade (I-II vs. III-IV) 0.074 2.161 (0.950-4.913) 0.066 Morphology of tumor thrombus 0.006 2.522 (1.191-5.343) 0.016 (Spherical vs. spiculated) Remnant Thrombus (post-operation) Venous thrombus <0.001 2.356 (1.283-4.325) 0.006 Pulmonary embolism 0.342 1.247 (0.607-2.562) 0.547 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e534 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Don kyoung Choi More articles by this author Hwang Gyun Jeon More articles by this author Byong Chang Jeong More articles by this author Seong Soo Jeon More articles by this author Hyun Moo Lee More articles by this author Han-Yong Choi More articles by this author Chang Wook Jeong More articles by this author Cheol Kwak More articles by this author Cheryn Song More articles by this author Jinsoo Chung More articles by this author Sung Kyu Hong More articles by this author Sung-Hoo Hong More articles by this author Seong Il Seo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prognostic Impact of Renin–Angiotensin System Blockade on Renal Cell Carcinoma After Surgery

Angiotensin 2 is a key biologic peptide in the renin-angiotensin system (RAS) that regulates blood pressure and renal hemodynamics. The potential role of the RAS in the promotion of tumor growth, angiogenesis, and metastasis also has been shown in the past few decades. This study investigated the prognostic impact of RAS blockade on patients with renal cell carcinoma (RCC) after surgery. The study identified 557 patients with pathologically diagnosed RCC (pT1-4 N0M0) and evaluated the prognostic factors after surgery for patients administered or not administered angiotensin-converting enzyme inhibitors (ACEs) or angiotensin 2 receptor blockers (ARBs). The median follow-up period was 5.1 years. Radical nephrectomy was performed for 349 patients (62.7 %), whereas the remaining 208 patients (37.3 %) underwent partial nephrectomy. A total of 104 patients (18.7 %) were administered RAS inhibitors: ACEs (n = 22) or ARBs (n = 82). Multivariate analysis showed that administration of RAS inhibitors (P = 0.044; HR 2.69), longer tumor length (P < 0.001; HR 1.02), high-grade tumor (P < 0.001; HR 3.55), and positive microvascular invasion (P < 0.003; HR 3.13) were not independent risk factors for a decrease in subsequent disease-specific survival after surgery for RCC. The 5-year disease-specific survival rate was 96.8 % among the patients administered RAS inhibitors and 89.8 % among their counterparts (P = 0.019). The authors propose renin-angiotensin blockade as a possible potent choice for effective treatment after surgical treatment of RCC.

Renal cell carcinoma and tumour thrombus in the inferior vena cava: clinical outcome of 98 consecutive patients and the prognostic value of preoperative parameters.

To evaluate the outcome of patients after nephrectomy and removal of tumour thrombus and to assess the prognostic value of preoperative parameters. Ninety-eight patients who were surgically treated between 2002 and 2011 were included. Patients' charts were reviewed, and patients with renal cell carcinoma (RCC) and concomitant tumour thrombus in the renal vein (RV) were compared with those with extended inferior vena cava (IVC) thrombus. Wilcoxon rank-sum test, Kaplan-Meier analysis and uni- and multivariate Cox regression analysis were used for statistical evaluation. Follow-up was 36 months (20-122 months), and 5-year disease-specific survival (DSS) and overall survival were 68.4 and 54.1 %, respectively. Patients with extended thrombus (levels 2-4) had higher intraoperative transfusion rates of concentrated red cells (CRC) and fresh-frozen plasma (FFP) compared with patients with thrombus confined to the RV (CRC: 5.8 vs. 1.5, p < 0.0001; FFP: 2.3 vs. 0.4, p = 0.0032). Surgery time (190 vs. 107 min, p < 0.0001), duration of hospitalisation (16 vs. 11 days, p = 0.0269), serum phosphate (3.64 vs. 3.29 mmol/l, p = 0.0369) and CRP levels (6.7 vs. 4.4 mg/dl, p = 0.0194) as well as aPTT were increased (33.7 vs. 29.6 s, p = 0.0059) in extended thrombus disease. In multivariate analysis, the presence of distant metastasis (p = 0.03) and lymphovascular invasion (p = 0.001), high platelet counts (p = 0.001) and high serum potassium levels (p = 0.032) proved to be independent prognostic factors. The surgical treatment of RCC with tumour thrombus in the RV or IVC has favourable results. Extended thrombus disease requires multidisciplinary approach. High serum potassium levels and platelet counts are associated with reduced DSS.

NSS for an RCC in a patient with renal insufficiency after heart transplant because of right ventricular tumor

The effect of the immunosuppressive therapy on the development of neoplasms has become the object of an ever increasing interest for clinicians all over the world. The literature on neoplasms development in the course of therapy following transplants has confirmed a considerable increase in the incidence of neoplasms of the skin and lymph nodes. Organ neoplasms developing in patients after transplants are characterized by increased progression, poor cellular diversification and a more unfavorable prognosis than in the general population The aim of the study is to present the case of a nephron–sparing surgery of a renal tumor (NSS) without any intraoperative ischaemia in a 55–year–old female patient with an orthotopic heart transplant and renal insufficiency following a prolonged immune suppression. It is estimated that the patients at the highest risk of neoplasm development are those in the first months after transplant, especially heart transplant. They require maximum doses of immunosuppressive drugs. In the case of patients with initial renal insufficiency the duration of ischaemia of the organ operated on should be minimized, and if possible, surgery should be conducted without clamping the renal pedicle. The surgical treatment of RCC (renal cell carcinoma) in transplant patients does not require any reduction in the amount of the immunosuppressive drugs.

The Contemporary Role of Surgery in Kidney Cancer

The diagnosis and treatment of renal cell carcinoma (RCC) has been the subject of major changes since the late 1980s. Initially, surgery was the only treatment available, but more recently, systemic therapies have been developed, and their introduction has modified some of the surgical indications for rcc. In addition, refinements in surgical technique and the introduction of minimally invasive approaches have revolutionized patient care and bear the promise of even more improvements to come. This paper provides an up-to-date overview of recent developments in the surgical treatment of RCC.