Urologic oncology
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Inferior vena caval tumor thrombus (IVC-TT) occurs in 10% of patients diagnosed with renal cell carcinoma (RCC). The perioperative management of these patients remains challenging. Despite multiple publications outlining surgical approaches and outcomes there have been few studies detailing the best peri-operative management of patients with IVC-TT. Our goal was to define the optimal management of patients with RCC and IVC-TT. ⋯ This study identified the available literature on the management of IVC-TT in association with RCC and was carefully reviewed by a multidisciplinary team. As a result, we have established a set of practice guidelines at our institution to help optimally manage patients with renal cell carcinoma and an inferior venal caval thrombus.
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Renal dysfunction is common in urologic patients, especially in those undergoing nephrectomy for renal cancer. Partial nephrectomy better preserves renal function than radical nephrectomy, but is associated with acute kidney injury related to loss of nephrons and ischemic injury. ⋯ Molecular markers, such as cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), IL-18 and kidney injury molecule-1 (KIM-1), better quantify the extent of acute ischemic and/or tubular injury than other currently available tools. The use of these and/or other markers may facilitate research to improve outcomes following partial nephrectomy.