Department of Urology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Urol Oncol. 2013 Oct;31(7):1298-304. doi: 10.1016/j.urolonc.2011.11.001. Epub 2011 Dec 9.
Surgical management of renal cell carcinoma (RCC) invading the inferior vena cava (IVC) remains a technical challenge. However, radical surgery is the only potentially curative treatment. We set out to review our experience of using a multi-specialty approach to these patients over the last 15 years.
Fifty patients with RCC and IVC invasion underwent surgery at our institution (mean age: 59 years). Tumor thrombus was infrahepatic/levels I and II: n = 24, intrahepatic/level III: N = 14, or suprahepatic/level IV: n = 12. Infra- and intrahepatic caval tumors were resected using an abdominal approach and liver transplant techniques without cardiopulmonary bypass (CPB). CPB was used only with level IV thrombus.
There were no intraoperative deaths. Median operating time was 6 hours and blood loss 3.5 liters (l). Staging was T3b: n = 34, T3c: n = 10 and T4: n = 6. Median time spent in HDU and hospital were 2 and 12.5 days, respectively. Perioperative mortality was 4%. Metastatic disease (P < 0.001) and level IV thrombus (P < 0.05) were significant negative prognostic factors. Forty of the 50 patients did not have metastasis. With mean follow-up of 38 months, the non-metastatic group had 2-year estimated Kaplan-Meier survival of 82.0% falling to 62.4% at 5 years. Conversely, in the metastatic group, estimated 2-year survival was 26.6% falling to 0% by 5 years.
Surgical treatment of RCC involving the IVC is possible with acceptable morbidity and mortality. Long-term survival can be expected in over 60% of non-metastatic patients at 5 years. These cases benefit from a multidisciplinary surgical approach. Level III thrombus can be successfully managed without CPB.
肾细胞癌（RCC）侵犯下腔静脉（IVC）的手术治疗仍然是一个技术挑战。然而，根治性手术是唯一潜在的治愈性治疗方法。我们旨在回顾过去 15 年来我们对这些患者采用多学科方法的经验。
在我们的机构，50 例 RCC 合并 IVC 侵犯的患者接受了手术治疗（平均年龄：59 岁）。肿瘤栓子位于肝下/水平 I 和 II：n = 24，肝内/水平 III：n = 14，或肝上/水平 IV：n = 12。使用腹部入路和肝移植技术切除肝下和肝内腔静脉肿瘤，不使用体外循环（CPB）。仅在 IV 级血栓时使用 CPB。
无术中死亡。中位手术时间为 6 小时，失血量为 3.5 升（l）。分期为 T3b：n = 34，T3c：n = 10，T4：n = 6。重症监护病房和住院时间中位数分别为 2 天和 12.5 天。围手术期死亡率为 4%。转移性疾病（P < 0.001）和 IV 级血栓（P < 0.05）是显著的负预后因素。50 例患者中有 40 例无转移。中位随访 38 个月后，无转移组患者 2 年估计 Kaplan-Meier 生存率为 82.0%，5 年时降至 62.4%。相反，在转移性组中，估计 2 年生存率为 26.6%，5 年时降至 0%。
IVC 受累的 RCC 手术治疗是可行的，具有可接受的发病率和死亡率。超过 60%的无转移患者在 5 年内可获得长期生存。这些病例受益于多学科手术方法。无需 CPB 即可成功治疗 III 级血栓。
