Surgical management of kidney cancer with associated vena cava tumor thrombus: A single-center multidisciplinary experience.

Abstract

Introduction: Kidney cancer (KC) with vena cava thrombus (VCT) is a rare but challenging disease. Surgery is associated with significant morbidity and mortality. The aim of our study is to report outcomes of patients with KC and VCT treated at our institution.

Materials and methods: We retrospectively analyzed data from 15 patients who underwent surgical treatment for KC with VCT at our institution between January 2004 and December 2022.

Results: Median age of patients was 70 years (range: 66-77 years) and 13 (86%) were males. The level of thrombus was infrahepatic in 11 patients (73%), retrohepatic in 1 case (6%), and atrial in 3 patients (20%). Radical nephrectomy with vena cava thrombectomy was performed in all patients. Cardiopulmonary bypass was required in three patients (20%). The median operative time was 4.2 h (range: 4.0-4.6 h) and median estimated blood loss was 675 ml (range: 300-1500 ml). Postoperatively, eight patients (53%) experienced complications, and 5 (62%) were Clavien-Dindo >3. After a median follow-up of 15 months (range: 10-49 months), seven patients (46.5%) were alive without evidence of disease, one was alive with disease, among the remainder 7 (46.5%), 5/7 (72%) patients died of other causes, only 2/7 (28%) died because of cancer.

Conclusions: Surgical resection of KC involving VCT represents a challenge for its high rate of complications. Multidisciplinary approach is often needed to achieve radicality safely. Oncological outcomes confirm the aggressiveness of the disease, with only roughly half (46.5%) of patients alive without disease at a median follow-up of 15 months.