Contemporary techniques and outcomes of surgery for locally advanced renal cell carcinoma with focus on inferior vena cava thrombectomy: The value of a multidisciplinary team.

Abstract

Objective:

To report the outcomes of surgery for a contemporary series of patients with locally advanced non-metastatic renal cell carcinoma (RCC) treated at a referral academic centre, focusing on technical nuances and on the value of a multidisciplinary team.

Methods:

We queried our prospective institutional database to identify patients undergoing surgical treatment for locally advanced (cT3-T4 N0-1 M0) renal masses suspected of RCC at our centre between January 2017 and December 2020.

Results:

Overall, 32 patients were included in the analytic cohort. Of these, 12 (37.5%) tumours were staged as cT3a, 8 (25.0%) as cT3b, 5 (15.6%) as cT3c, and 7 (21.9%) as cT4; 6 (18.8%) patients had preoperative evidence of lymph node involvement. Nine (28.1%) patients underwent nephron-sparing surgery while 23 (71.9%) received radical nephrectomy. A template-based lymphadenectomy was performed in 12 cases, with evidence of disease in 3 (25.0%) at definitive histopathological analysis. Four cases of RCC with level IV inferior vena cava thrombosis were successfully treated using liver transplant techniques without the need for extracorporeal circulation. While intraoperative complications were recorded in 3 (9.4%) patients, no postoperative major complications (Clavien-Dindo ≥3) were observed. At histopathological analysis, 2 (6.2%) patients who underwent partial nephrectomy harboured oncocytoma, while the most common malignant histotype was clear cell RCC (62.5%), with a median Leibovich score of 6 (interquartile range 5-7).

Conclusion:

Locally advanced RCC is a complex and heterogenous disease posing several challenges to surgical teams. Our experience confirms that provided careful patient selection, surgery in experienced hands can achieve favourable perioperative, oncological, and functional outcomes.

• Authors: Riccardo Campi, Paolo Barzaghi, Alessio Pecoraro, Maria Lucia Gallo, Damiano Stracci, Alberto Mariotti, Saverio Giancane, Simone Agostini, Vincenzo Li Marzi, Arcangelo Sebastianelli, Pietro Spatafora, Mauro Gacci, Graziano Vignolini, Francesco Sessa, Paolo Muiesan, Sergio Serni
• Journal: Asian journal of urology (Asian J Urol) Vol. 9 Issue 3 Pg. 272-281 (Jul 2022) ISSN: 2214-3882 [Print] Singapore
• PMID: 36035338 (Publication Type: Journal Article)
• Copyright: © 2022 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.