Surgical Management and Oncologic Outcomes of Recurrent Venous Tumor Thrombus after Prior Nephrectomy for Renal Cell Carcinoma

Background While the management of a venous tumor thrombus in renal cell carcinoma is well described, there is a paucity of evidence to guide care in patients who recur within the vena cava. Objective To report our experience with patients presenting with recurrent venous tumor thrombi after prior radical nephrectomy. Design, setting, and participants A retrospective review of 16 patients from 1970 to 2013 with a history of renal cell carcinoma treated surgically for a recurrent tumor thrombus unrelated to a new renal tumor. Intervention Recurrent tumor thrombectomy. Outcome measurements and statistical analysis Intraoperative outcomes, recurrence-free survival, and cancer-specific survival following resection. Results and limitations Of the 16 patients, three patients were diagnosed with synchronous widely metastatic disease, did not undergo recurrent tumor thrombectomy, and died within 6 mo. Among the remaining 13 repeat surgical patients, the median age was 67 (range: 48–76) yr with a median time from prior nephrectomy to diagnosis of 6 (range: 3–58) mo. Nine patients had known tumor thrombus at nephrectomy, all of whom were thought to have complete tumor thrombectomy at initial surgery. During exploration for recurrent thrombus, surgical resection was completed in 11, with a median blood loss of 2500 (range: 200–7000) ml, and a median transfusion requirement of four (range: 0–18) units. At a median follow-up of 12 mo all patients had recurred and died of disease. The median time to recurrence and death was 4 mo and 12 mo following repeat exploration, respectively. Conclusions Recurrent tumor thrombectomy is a technically feasible yet challenging operation. Survival is poor in this population with metastatic progression appreciated in all patients in our series. Patient summary In this report we evaluated outcomes for patients presenting with vena cava tumor thrombus after prior nephrectomy for renal cell carcinoma. We found that surgical excision is complex yet feasible and that survival following resection was poor.