Miao Chenkui, Wang Yuhao, Hou Chao, Chen Wen, Xu Aiming, Wang Zengjun
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
Transl Androl Urol. 2020 Apr;9(2):812-818. doi: 10.21037/tau.2019.12.13.
Renal tumor with inferior vena cava (IVC) tumor thrombus still remains one of the most medical challenges in urological oncology. Despite numerous researches reporting the surgical experiences and survivals of this kind of patients, there is still lacking a standard recommended therapy right now. We reported a case of metastatic renal cell carcinoma with Mayo III IVC tumor thrombus who underwent robotic-assisted complete removal of the intracaval thrombus and radical left nephrectomy followed by renal arterial chemoembolization and pazopanib administration. It provides a new scheme and mode of diagnosis and treatment for this kind of patients. The patient was a 50-year-old man with left low-back pain for 20 days diagnosed with left renal tumor and Mayo III IVC tumor thrombus at the earliest. Initially, the patient underwent the renal arterial chemoembolization and targeted treatment to inhibit tumor's progression. After a two-year therapy period, the size of renal mass and lung nodules decreased than before, as well as the IVC tumor thrombus dropped to level II. Considering the efficacy of previous treatments, we performed robot-assisted IVC thrombectomy and radical left nephrectomy for this patient. The post-operative pathological examination confirmed the diagnosis of tumor thrombus as renal clear cell carcinoma. The patients recovered well after surgery and was followed-up for 36 months during the whole treatment course. This case with metastatic renal cell carcinoma (mRCC) and Mayo III IVC tumor thrombus received the interventional therapy, molecular targeted therapy and robot-assisted surgery successively, and acquired satisfying outcome. Patients with mRCC always suffer shorter overall survivals and aggressive progression compared with those localized tumors, therefore it is essential to formulate rational comprehensive treatment and carry out in time following-up.
伴有下腔静脉（IVC）瘤栓的肾肿瘤仍是泌尿外科肿瘤学中最具医学挑战性的问题之一。尽管有大量研究报道了这类患者的手术经验和生存率，但目前仍缺乏标准的推荐治疗方法。我们报告了一例伴有梅奥III级IVC瘤栓的转移性肾细胞癌患者，该患者接受了机器人辅助下腔静脉瘤栓完全切除术和根治性左肾切除术，随后进行了肾动脉化疗栓塞和帕唑帕尼治疗。这为这类患者提供了一种新的诊疗方案和模式。该患者为50岁男性，因左腰背痛20天就诊，最初诊断为左肾肿瘤伴梅奥III级IVC瘤栓。起初，患者接受了肾动脉化疗栓塞和靶向治疗以抑制肿瘤进展。经过两年的治疗期，肾肿块和肺结节的大小比之前减小，下腔静脉瘤栓降至II级。考虑到先前治疗的效果，我们为该患者实施了机器人辅助下腔静脉血栓切除术和根治性左肾切除术。术后病理检查确诊瘤栓为肾透明细胞癌。患者术后恢复良好，整个治疗过程中随访了36个月。该例伴有梅奥III级IVC瘤栓的转移性肾细胞癌（mRCC）患者先后接受了介入治疗、分子靶向治疗和机器人辅助手术，并取得了满意的结果。与局限性肿瘤患者相比，mRCC患者的总生存期总是较短且进展迅速，因此制定合理的综合治疗方案并及时进行随访至关重要。
