• Revista médica de Chile · Aug 2022

    [Vena cava thrombectomy in kidney cancer. Report of 32 nephrectomies].

    • Pablo A Rojas, Juan Cristóbal Bravo, Renato Navarro, Sofía Villagran, Álvaro Zúñiga, Pablo Troncoso, Pedro Becker, Eduardo Briceño, and FranciscoIgnacio F SanIFSDepartamento Urología, Facultad de medicina, Pontificia Universidad Católica de Chile, Santiago, Chile..
    • Departamento Urología, Facultad de medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
    • Rev Med Chil. 2022 Aug 1; 150 (8): 994999994-999.

    BackgroundVena cava (VC) involvement in kidney tumors occurs in 4 to 10% of cases, and is associated with a higher mortality. Nephrectomy with thrombectomy of the VC, performed by a multidisciplinary team, improves survival.AimTo report a series of consecutive nephrectomies with caval thrombectomy performed in an academic center.Patients And MethodsWe report 32 patients with cT3b and 3c renal tumors, who underwent radical nephrectomy with VC thrombectomy between 2001 and 2021. A descriptive analysis of clinical, surgical and pathological variables was performed. Overall survival (OS) and cancer-specific survival (CSS) was calculated using Kaplan-Meier curves.ResultsThe mean tumor size was 9.7 cm. According to Mayo classification 3/32 (9%) patients had a type I thrombus, 10/32 (31%) had a type II thrombus, 8/32 (25%) had a type III thrombus, and 5/32 (16%) had a type IV thrombus. The mean bleeding was 2000 cc. There was one intraoperative death. Nineteen percent of patients had complications >= 3 according to Clavien-Dindo classification. Reoperations occurred in 9%. Pre and postoperative creatinine levels were 1.17 and 1.91 mg/dl respectively (p < 0.01). Pre and postoperative Hematocrit levels were 47.9 and 31% respectively (p = 0.02). Sixty six percent of tumors were clear cell renal cancer, 9% were papillary and 3% were chromophobic. Mean OS was 10 months. Two-year SCE was 40%.ConclusionsOur results are similar to those reported elsewhere. Despite being an unusual pathology, the surgical technique has been improving, thanks to the multidisciplinary work of urologists and surgeons.

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