Pirola Giacomo Maria, Saredi Giovanni, Damiano Giuseppe, Marconi Alberto Mario
Urology Unit, Ospedale di Circolo e Fondazione Macchi, Varese.
Arch Ital Urol Androl. 2013 Dec 31;85(4):175-9. doi: 10.4081/aiua.2013.4.175.
To review the 10-year experience of our urological unit in the surgical management of renal cell carcinoma (RCC) with neoplastic tumor thrombosis focusing on postoperative survival.
We underwent a retrospective analysis of the patients treated for this pathology during the last decade 2002-2012, stratifying them by tumor thrombus level and histological subtype. Kaplan-Meyer curves were used to assess survival.
Overall, 67 patients underwent surgery for RCC with neoplastic tumoral thrombosis in the period under review. 60 were clear cell RCC, 4 were urothelial papillary tumors of the renal pelvis and 3 were rare histotypes, as a nefroblastoma, a spinocellular tumor of the renal pelvis and an unclassifiable renal carcinoma. Thrombus level was I in 40 cases, II in 17, III in 2 and IV in 8 patients. We report the main postoperative complications and our survival data, with mean follow up of 36 months. Tumor stage is the most important variable in predicting survival. Patients with N0M0 disease had 70% survival at 36 months, instead of 20% for those with primitive metastatic tumor.
Our survival results fit with the main reports in literature and our surgical management was completely in keeping with international guidelines. We did not observe relevany post-operative complications, except of hemorrhagic ones that occurred in 6 patients (9% of total) and were always successfully managed. Eighteen patients (26.87% of total) underwent caval filter positioning, without evidence of complications during its positioning or removal. Life expectancy was particularly low for the cases of RCC without clear cell histotype (7 cases in our series, 10.4% of total) that always was less than one year from surgery.
回顾我们泌尿外科在肾细胞癌（RCC）伴肿瘤血栓手术治疗方面的10年经验，重点关注术后生存率。
我们对2002年至2012年这十年间接受该疾病治疗的患者进行了回顾性分析，根据肿瘤血栓水平和组织学亚型对他们进行分层。采用Kaplan - Meyer曲线评估生存率。
总体而言，在审查期间，67例患者因RCC伴肿瘤血栓接受了手术。其中60例为透明细胞RCC，4例为肾盂尿路上皮乳头状肿瘤，3例为罕见组织学类型，如肾母细胞瘤、肾盂棘细胞瘤和无法分类的肾癌。40例患者血栓水平为I级，17例为II级，2例为III级，8例为IV级。我们报告了主要的术后并发症和生存数据，平均随访36个月。肿瘤分期是预测生存的最重要变量。N0M0期疾病患者36个月生存率为70%，而有原发性转移肿瘤的患者为20%。
我们的生存结果与文献中的主要报道相符，我们的手术管理完全符合国际指南。除了6例患者（占总数的9%）发生出血性并发症且均成功处理外，我们未观察到其他相关术后并发症。18例患者（占总数的26.87%）进行了下腔静脉滤器置入，在置入或取出过程中均无并发症迹象。对于无透明细胞组织学类型的RCC病例（我们系列中有7例，占总数的10.4%），预期寿命特别低，术后生存期总是少于一年。
