Berczi Akos, Flasko Tibor, Szerafin Tamas, Thomas Ben, Bacso Zsolt, Berczi Csaba
Department of Cardiac Surgery, University of Debrecen, Debrecen, Hungary.
Urol Int. 2017;99(3):267-271. doi: 10.1159/000464108. Epub 2017 Mar 3.
The authors of this paper assessed the surgical management and outcome of renal cancers when tumor thrombus extended into the inferior vena cava (IVC).
From 2000 to 2015, 46 radical nephrectomies were performed on patients with tumor thrombus in the IVC. The mean age of the patients was 60 ± 11 years. Radical nephrectomy and thrombectomies were performed in a single session. There were 18 level-IV, 23 level-III, and 5 level-II tumor thrombi. The operations were performed using cardiopulmonary bypass in 14 patients, while deep hypothermic cardiac arrest was carried out in 4 cases.
The mean size of the tumors was 9.4 ± 3.5 cm. Histology showed the tumor stages to be pT3b in 21cases, pT3c in 22, and pT4 in 3 patients. The mean follow-up period of the patients was 3.6 ± 3.0 years. During the follow-up period, local recurrence was observed in 7 patients, while distant metastases occurred in 8 cases. The median time to progression was 37 ± 27 months. The 5-year overall survival was 43.7%.
Radical nephrectomy and thrombectomy provided reasonable long-term survival for patients with renal cancer and IVC thrombus. However, tumor progression was detected in 41.6%. The presence of tumor thrombus had a negative effect on tumor progression and survival.
本文作者评估了肿瘤血栓延伸至下腔静脉（IVC）时肾癌的外科治疗及预后。
2000年至2015年，对46例下腔静脉有肿瘤血栓的患者实施了根治性肾切除术。患者的平均年龄为60±11岁。根治性肾切除术和血栓切除术在同一手术中进行。有18例IV级、23例III级和5例II级肿瘤血栓。14例患者手术时使用了体外循环，4例患者实施了深低温停循环。
肿瘤的平均大小为9.4±3.5cm。组织学检查显示，21例患者的肿瘤分期为pT3b，22例为pT3c，3例为pT4。患者的平均随访期为3.6±3.0年。随访期间，7例患者出现局部复发，8例发生远处转移。进展的中位时间为37±27个月。5年总生存率为43.7%。
根治性肾切除术和血栓切除术为患有肾癌和下腔静脉血栓的患者提供了合理的长期生存。然而，41.6%的患者出现了肿瘤进展。肿瘤血栓的存在对肿瘤进展和生存有负面影响。
