Renal cell carcinoma with IVC thrombectomy, Single Centre surgical experience of 3 years– A Case Series
Keywords:
RCC, IVC thrombus, clinical presentation, surgical management, complications, prognosis, clavien dindoAbstract
Objective
To report our experience of clinical outcomes and complications of open Radical Nephrectomy with Inferior Venacaval thrombectomy in patients with RCC as per new Clavien-Dindo method and compare with our previously published data.
Patients and methods
Total 13 patients who underwent radical nephrectomy and IVC thrombectomy without the help of cardiopulmonary bypass between Jan 2017 to Dec 2019 were included in this retrospective analysis.
Data were collected and analyzed by SPSS software and compared with our previous published data.
Results
The median age was 55years, and 10 (76%) of them were men. Surgery was done by midline abdominal incision. The median duration of surgery was 289mins, and median blood loss was 1061ml.The extent of tumour thrombus was intrahepatic in 8, retro hepatic in 4 and suprahepatic in 1 patient. Complications as per Clavien Dindo Classification were anemia (Hb<8mg/dl) requiring transfusion of blood products (Gr.II) in all patients. In immediate postoperative period, 1(7%) patient developed acute kidney injury (Gr.I), 4(30%) patients had evidence of hypotension (Gr.II), while 2(15%) patients required hemodynamic support. Paralytic ileus (Gr.I) was seen in 1(7%) patient and 2(15%) patients had symptoms of cough and breathlessness due to atelectasis (Gr.I) of lower lobes of lungs. Lastly 1 patient had sepsis (Gr.IVa), 1 patient had partial wound dehiscence (Gr.IIIa) requiring secondary suturing under local anaesthesia and 1 patient eventually progressed to chronic kidney failure (Gr.IVa) requiring intermittent dialysis. At median 3 years follow up, 12/13 patients are alive and well and 1 patient developed local relapse and is on targeted therapy.
Conclusion
Radical nephrectomy with IVC thrombectomy still remains the most effective therapeutic option in management for renal cell carcinoma with IVC thrombus. Although this is complicated surgery, our data suggests that with multi-disciplinary approach not only complications can be reduced but excellent survival outcome can be achieved. Lastly with the help of new Clavien an Dindo classification, there is a uniformity in classifying the complications which can be used to compare with other studies later on.
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