Nephrectomy and vena caval thrombectomy in patients with metastatic renal cell carcinoma.
Urology
; 50(5): 673-7, 1997 Nov.
Article
en En
| MEDLINE
| ID: mdl-9372873
ABSTRACT
OBJECTIVES:
To report out experience with performing nephrectomy and vena caval thombectomy in patients with metastatic renal cell carcinoma.METHODS:
A retrospective review was performed of 15 patients who underwent surgical excision of the primary tumor and a caval thrombus and treatment of concurrent metastases between 1989 and 1995. The sites of metastases included lungs (n = 8), bone (n = 3), bulky retroperitoneal or mediastinal lymph nodes (n = 2), liver (n = 1), and contralateral adrenal (n = 1). The level of caval involvement was suprahepatic in 3 cases, retrohepatic in 2 cases, and infrahepatic in 10 cases. Three patients had an Eastern Cooperative Oncology Group performance score of 0, 11 had a score of 1, and 1 had a score of 2. Median follow-up was 17 months.RESULTS:
Median operative time was 6.5 hours and median hospitalization was 10 days. Two patients required re-exploration for postoperative hemorrhage. There were no perioperative deaths. Four patients underwent surgery for resection of solitary metastases (1 lung, 2 spine, and 1 humerus); 2 of the 4 received adjuvant radiotherapy. Two patients received biologic therapy preoperatively, 3 received it both preoperatively and postoperatively, and 6 received it only postoperatively. The median time to initiation of postoperative biologic therapy was 48 days (range 25 to 110). Eleven patients are currently alive, 7 with no evidence of disease at a median follow-up of 17 months (range 6 to 66) and 4 with stable metastases at 14 months (range 4 to 22). Ten of the 13 symptomatic patients had improved performance scores after surgery. Four patients have died from metastatic disease 2 from rapid progression at 2 and 5 months after surgery and the other 2 at 17 and 42 months.CONCLUSIONS:
Nephrectomy and vena caval thrombectomy can be safely performed in selected patients with metastatic disease. Furthermore, in patients receiving biologic therapy, nephrectomy may enable a better quality of life and prolonged survival.
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Banco de datos:
MEDLINE
Asunto principal:
Vena Cava Inferior
/
Carcinoma de Células Renales
/
Neoplasias Renales
/
Células Neoplásicas Circulantes
/
Nefrectomía
Tipo de estudio:
Observational_studies
Límite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Urology
Año:
1997
Tipo del documento:
Article
País de afiliación:
Estados Unidos