Bastian P J, Haferkamp A, Akbarov I, Albers P, Müller S C
Klinik und Poliklinik für Urologie, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms Universität, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
Eur J Surg Oncol. 2005 May;31(4):420-3. doi: 10.1016/j.ejso.2004.12.005. Epub 2005 Jan 28.
To report our experience with extensive surgery in patients with and without metastatic renal cell carcinoma and gross venous tumour thrombus.
Twenty-seven patients with unilateral renal cell carcinoma and tumour thrombus into the vena cava underwent radical nephrectomy and thrombectomy. Eight patients presented with metastatic disease at the time of surgery. Mean follow-up was 17 months (1-54 months, median 9 months). Follow-up was available for 26 patients (96%).
Thirteen patients were alive at the time of the study; 11 without evidence of disease with a mean follow-up of 25 months and two (one with and one without metastasis at surgery) with distant metastasis at 16 and 36 months. Eleven patients have died of progressive disease. Mean survival in patients (19 patients) without metastatic disease at time of surgery was 15.2 months; patients (seven patients) with metastatic disease at surgery had a mean survival of 6.7 months.
Radical nephrectomy and vena caval tumour thrombectomy can be performed in selected patients with an acceptable complication rate. Patients without metastatic disease have a better prognosis than patients with metastatic disease.
报告我们对有或无转移性肾细胞癌及肉眼可见静脉瘤栓患者进行广泛手术的经验。
27例单侧肾细胞癌且瘤栓累及腔静脉的患者接受了根治性肾切除术及血栓切除术。8例患者在手术时出现转移性疾病。平均随访时间为17个月（1 - 54个月，中位数9个月）。26例患者（96%）有随访资料。
研究时13例患者存活；11例无疾病证据，平均随访25个月，2例（1例手术时有转移，1例无转移）分别在16个月和36个月出现远处转移。11例患者死于疾病进展。手术时无转移性疾病的患者（19例）平均生存期为15.2个月；手术时有转移性疾病的患者（7例）平均生存期为6.7个月。
对于部分患者，根治性肾切除术及腔静脉瘤栓切除术可在可接受的并发症发生率下进行。无转移性疾病的患者比有转移性疾病的患者预后更好。
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