Kulkarni Jagdeesh, Jadhav Yogesh, Valsangkar Rohan S
Department of Urology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra India.
Indian J Surg Oncol. 2012 Jun;3(2):107-13. doi: 10.1007/s13193-011-0114-2. Epub 2011 Dec 20.
To review our experience of RCC with IVC thrombus in terms of clinical presentation, principles of surgical management in contemporary era, also an impact of clinico-pathological factors on prognosis. Total 100 patients who underwent radical nephrectomy and IVC thrombectomy between 1991-2008 were included in this retrospective analysis. Data was analysed in terms of clinical pathological factors, survivals and compared with contemporary literature. The extent tumour thrombus was infrahepatic in 58 retro hepatic in 28 and suprahepatic in 14 patients including 6 with right atrial thrombus. The immediate postoperative mortality was 2% and incidence of major postoperative non fatal complications was 38%, which were managed conservatively. The overall and disease free 5 year survival was 63% and 55%. Further amongst the histological types, patients with clear cell tumours had the best (DFS- 71.42%), and those with papillary had the poor (DFS- 30.76%) outcome. Grade II tumors had better survivals as compared to grade IV (DFS 75.39% vs 23.52%, p < 0.05). Loco- regional extent wise 74% patients without perinephric fat invasion were free from disease at 5 years as compared to 30% of those who had perinephric fat invasion (p < 0.01). Similarly 5 year DFS was 76.11% in patients with negative nodes as compared to 12% in positive nodes (p < 0.01). In conclusion radical nephrectomy with IVC thrombectomy still remains the most effective therapeutic option in management in this clinical setting. Although this is complicated surgery success with multi disciplinary approach excellent survival outcome can be obtained. Further pathological factors, such as loco-regional spread and grade of tumor, rather than clinical factors influence long term survival.
回顾我们在肾细胞癌合并下腔静脉血栓形成方面的经验，包括临床表现、当代手术治疗原则，以及临床病理因素对预后的影响。本回顾性分析纳入了1991年至2008年间接受根治性肾切除术和下腔静脉血栓切除术的100例患者。根据临床病理因素、生存率进行数据分析，并与当代文献进行比较。肿瘤血栓范围：58例为肝下型，28例为肝后型，14例为肝上型，其中6例合并右心房血栓。术后即刻死亡率为2%，术后主要非致命并发症发生率为38%，均经保守治疗。5年总生存率和无病生存率分别为63%和55%。在组织学类型中，透明细胞肿瘤患者的预后最佳（无病生存率为71.42%），而乳头状肿瘤患者的预后最差（无病生存率为30.76%）。Ⅱ级肿瘤的生存率优于Ⅳ级（无病生存率分别为75.39%和23.52%，p<0.05）。局部区域范围方面，5年时74%未侵犯肾周脂肪的患者无疾病复发，而侵犯肾周脂肪的患者这一比例为30%（p<0.01）。同样，淋巴结阴性患者的5年无病生存率为76.11%。
