Nason Gregory J, Ajib Khaled, Tan Guan Hee, Woon Dixon T S, Christakis George T, Nam Robert K
Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada.
Division of Cardiac Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada.
Can Urol Assoc J. 2021 Apr;15(4):E199-E204. doi: 10.5489/cuaj.6736.
Patients with renal cell carcinoma (RCC) with level 3 or 4 caval thrombus have a poor prognosis, with reported five-year survival rates of 30-40%. The aim of this study was to assess the perioperative morbidity and long-term oncological outcomes for radical nephrectomy with resection of vena cava thrombus using a combined surgical approach, including extracorporeal circulation and deep hypothermic circulatory arrest.
A retrospective review was performed of the institutional case log to identify all radical nephrectomies with caval thrombus performed from January 2006 to May 2020.
Twenty-five patients were identified with level 2 thrombus in one (4%), level 3 thrombus in eight (32%), and level 4 in 16 (64%). The median followup was 20.6 months (range 0.2-133.3). The median age at surgery was 68.4 years (range 44.2-85.5). Twenty-one (84%) patients were symptomatic at presentation. Six (24%) patients had distant metastases at diagnosis. The median circulatory arrest time was 15 minutes (range 6-35). The 30-day grade ≥3 complication rate was 8%. The 30-day mortality rate was 8%. The one-year, two-year, three-year, and five-year recurrence-free survival (RFS) rates were 53%, 18%, 10%, and 10%, respectively. The median time to systemic treatment was 7.7 months (range 1.2-25.7). The one-year, two-year, three-year, and five-year overall survival (OS) rates were 70%, 43%, 36%, and 31%, respectively.
Radical nephrectomy with resection of vena cava thrombus using extracorporeal circulation and deep hypothermic circulatory arrest is associated with some morbidity and mortality but remains a safe and effective strategy for advanced RCC patients who would otherwise be managed palliatively.
患有3级或4级腔静脉血栓的肾细胞癌（RCC）患者预后较差，据报道其五年生存率为30%-40%。本研究的目的是评估采用包括体外循环和深低温停循环在内的联合手术方法进行根治性肾切除术并切除腔静脉血栓的围手术期发病率和长期肿瘤学结局。
对机构病例记录进行回顾性分析，以确定2006年1月至2020年5月期间所有进行的伴有腔静脉血栓的根治性肾切除术。
确定了25例患者，其中1例（4%）为2级血栓，8例（32%）为3级血栓，16例（64%）为4级血栓。中位随访时间为20.6个月（范围0.2-133.3个月）。手术时的中位年龄为68.4岁（范围44.2-85.5岁）。21例（84%）患者就诊时出现症状。6例（24%）患者在诊断时已有远处转移。中位停循环时间为15分钟（范围6-35分钟）。30天≥3级并发症发生率为8%。30天死亡率为8%。1年、2年、3年和5年无复发生存率（RFS）分别为53%、18%、10%和10%。全身治疗的中位时间为7.7个月（范围1.2-25.7个月）。1年、2年、3年和5年总生存率（OS）分别为70%、43%、36%和31%。
采用体外循环和深低温停循环切除腔静脉血栓的根治性肾切除术虽伴有一定的发病率和死亡率，但对于那些否则将接受姑息治疗的晚期RCC患者而言，仍是一种安全有效的策略。
