Surgery for renal cell cancer extending into the inferior vena cava - evaluation of survival and perioperative complications using a standardized classification system.

Abstract

• To present a single-centre experience of surgery for kidney cancer involving vena cava thrombus with surgical technique, complications and outcome using a standardized classification system for perioperative complications. • Sixty-eight consecutive cases were retrospectively analysed. Thrombus extension was at level I (but inside the vena cava) in 10 cases, level II in 28 cases, level III in 18 cases and level IV in 12 cases; 18 patients had distant metastases. • Radical tumour nephrectomy was performed in all cases. Complete liver mobilization was carried out in 23 cases and cardiovascular bypass with circulatory arrest was performed in five cases. • Follow-up was available for 66 patients. Median follow-up was 29 months (interquartile range 30.75). • The 28-day mortality was 0%. • According to the Clavien-Dindo classification there were two grade 1, 54 grade 2, two grade 3a, two grade 3b and two grade 4a perioperative complications. • The factors pN, grading and metastases at presentation predicted overall survival in univariate analyses. In a multivariate model none of the factors age, metastases at presentation, pN, WHO-grading, American Society of Anesthesiologists score, tumour size and thrombus level significantly predicted survival. • Immediate target therapy with neoadjuvant intention in three patients did not result in surgical therapy. • Aggressive surgical treatment causes no perioperative mortality and leads to a low rate of grade 3 and grade 4 complications (8.8%). • A median overall survival of 47 months shows that surgical treatment has favourable results in these patients.