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- Title
Radiologic indicators prior to renal cell cancer thrombectomy: Implications for vascular reconstruction and mortality.
- Authors
Overholser, Stephen; Raheem, Omer; Zapata, David; Kaushik, Dharam; Rodriguez, Ronald; Derweesh, Ithaar H.; Liss, Michael A.
- Abstract
Background: Renal cancer may invade the inferior vena cava (IVC) creating more complex surgical intervention. We investigate radiologic findings that may predict vascular reconstruction prior to surgery and future renal cancer-specific mortality. Materials and Methods: Radiologic findings included Mayo Clinic risk factors for vascular reconstruction: Right-sided tumor, anteroposterior diameter of the IVC at the ostium of the renal vein ≥24.0 mm, and radiologic identification of complete occlusion of the IVC. Additional factors included thrombus in the lumen of the hepatic veins and metastasis. Along with other demographic factors, analysis included Chi-squared analysis for vascular reconstruction and logistic regression for mortality. A Kaplan--Meier curve was created for the most significant radiologic factor. Results: Thirty-seven patients underwent IVC tumor thrombectomy at two institutions from April 2007 to February 2015. We found that Mayo risk factors of 0, 1, 2, and 3 and the proportions of vascular reconstruction of 0%, 0%, 12.5%, and 13.6%, respectively (P = 0.788). Hepatic vein involvement was the most significant determinate of renal cell carcinoma-specific mortality in multivariable analysis, controlling for the size of IVC at the hepatic veins, pulmonary metastasis, and Fuhrman grade (P = 0.02, Log-rank P = 0.002). Conclusion: Mayo risk factors did not predict vascular reconstruction in our small cohort of Level II--Level IV IVC thrombus undergoing IVC thrombectomy. Tumor thrombus traveling into the lumen of the hepatic veins was a significant risk factor for accelerated mortality.
- Subjects
RENAL cell carcinoma; MORTALITY; RADIOLOGY; SURGERY; TUMORS; THROMBOSIS
- Publication
Urology Annals, 2016, Vol 8, Issue 3, p312
- ISSN
0974-7796
- Publication type
Article
- DOI
10.4103/0974-7796.184888