The Mayo-Clinic experience with surgical management complications and outcome for patients with renal cell carcinoma and venous tumour thrombus

Michael L. Blute, Bradley C. Leibovich, Christine M. Lohse, John C. Cheville, Horst Zincke

Research output: Contribution to journalArticle

270 Citations (Scopus)

Abstract

OBJECTIVE: To report the surgical management, complications and outcomes over three decades by tumour thrombus level for patients with renal cell carcinoma (RCC) and renal venous extension, as surgery is the most effective treatment. PATIENTS AND METHODS: We assessed 540 patients who underwent surgical resection for RCC with renal venous extension between 1970 and 2000. Early and late surgical complications, including operative mortality, were compared with tumour thrombus level using the chi-square, Fisher's exact and Wilcoxon rank-sum tests. Cancer-specific survival was estimated using the Kaplan-Meier method and compared across tumour thrombus levels using log-rank tests. RESULTS: There were 349 (64.6%) patients with level O thrombus and 191 (35.4%) with inferior vena cava thrombus, including 66 (12.2%) with level I, 77 (14.3%) with level II, 28 (5.2%) with level III, and 20 (3.7%) with level IV thrombus. Patients with a higher thrombus level had more early surgical complications (respectively for level 0 to IV, 8.6%, 15.2%, 14.1%, 17.9% and 30.0%, P < 0.001). However, there was no statistically significant difference in the incidence of late complications by thrombus level (P = 0.445). The incidence of any early surgical complication decreased from 13.4% for patients treated in 1970-1989 to 8.1% for those treated in 1990-2000 (P = 0.064); the respective operative mortality decreased from 3.8% to 2.0% (P = 0.260), and in patients with inferior vena cava thrombus, from 8.1% to 3.8% (P = 0.227). The respective duration of hospitalization decreased from a median of 8 to 7 days (P < 0.001) but the incidence of late complications increased significantly over time (P < 0.001.) Among patients with clear cell RCC, the respective estimated 5-year cancer-specific survival rates (SE, number still at risk) for patients with level 0 to IV thrombus were 49.1 (3.0)% (125), 31.7 (6.4)% (14), 26.3 (6.1)% (11), 39.4 (10.7)% (7) and 37.0 (12.9)% (5), (P = 0.028). There was a statistically significant difference in outcome for patients with level 0 vs those with level >0 thrombus (P = 0.002), but there was no significant difference in outcome by thrombus level among patients with inferior vena cava tumour thrombus (P = 0.868). CONCLUSIONS: The surgical management of RCC with renal venous extension continues to develop. The incidence of early surgical complications and operative death have decreased in recent times with the introduction of improved imaging, surgical monitoring and vascular bypass techniques. There is significantly better cancer-specific survival for patients with renal vein involvement only than those with inferior vena cava involvement.

Original languageEnglish (US)
Pages (from-to)33-41
Number of pages9
JournalBJU International
Volume94
Issue number1
DOIs
StatePublished - Jul 2004

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Renal Cell Carcinoma
Thrombosis
Neoplasms
Inferior Vena Cava
Nonparametric Statistics
Kidney
Renal Veins
Survival
Blood Vessels
Mortality
Incidence

Keywords

  • Renal cell carcinoma
  • Surgical management and outcomes
  • Venous tumour thrombus

ASJC Scopus subject areas

  • Urology

Cite this

The Mayo-Clinic experience with surgical management complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. / Blute, Michael L.; Leibovich, Bradley C.; Lohse, Christine M.; Cheville, John C.; Zincke, Horst.

In: BJU International, Vol. 94, No. 1, 07.2004, p. 33-41.

Research output: Contribution to journalArticle

Blute, Michael L. ; Leibovich, Bradley C. ; Lohse, Christine M. ; Cheville, John C. ; Zincke, Horst. / The Mayo-Clinic experience with surgical management complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. In: BJU International. 2004 ; Vol. 94, No. 1. pp. 33-41.
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abstract = "OBJECTIVE: To report the surgical management, complications and outcomes over three decades by tumour thrombus level for patients with renal cell carcinoma (RCC) and renal venous extension, as surgery is the most effective treatment. PATIENTS AND METHODS: We assessed 540 patients who underwent surgical resection for RCC with renal venous extension between 1970 and 2000. Early and late surgical complications, including operative mortality, were compared with tumour thrombus level using the chi-square, Fisher's exact and Wilcoxon rank-sum tests. Cancer-specific survival was estimated using the Kaplan-Meier method and compared across tumour thrombus levels using log-rank tests. RESULTS: There were 349 (64.6{\%}) patients with level O thrombus and 191 (35.4{\%}) with inferior vena cava thrombus, including 66 (12.2{\%}) with level I, 77 (14.3{\%}) with level II, 28 (5.2{\%}) with level III, and 20 (3.7{\%}) with level IV thrombus. Patients with a higher thrombus level had more early surgical complications (respectively for level 0 to IV, 8.6{\%}, 15.2{\%}, 14.1{\%}, 17.9{\%} and 30.0{\%}, P < 0.001). However, there was no statistically significant difference in the incidence of late complications by thrombus level (P = 0.445). The incidence of any early surgical complication decreased from 13.4{\%} for patients treated in 1970-1989 to 8.1{\%} for those treated in 1990-2000 (P = 0.064); the respective operative mortality decreased from 3.8{\%} to 2.0{\%} (P = 0.260), and in patients with inferior vena cava thrombus, from 8.1{\%} to 3.8{\%} (P = 0.227). The respective duration of hospitalization decreased from a median of 8 to 7 days (P < 0.001) but the incidence of late complications increased significantly over time (P < 0.001.) Among patients with clear cell RCC, the respective estimated 5-year cancer-specific survival rates (SE, number still at risk) for patients with level 0 to IV thrombus were 49.1 (3.0){\%} (125), 31.7 (6.4){\%} (14), 26.3 (6.1){\%} (11), 39.4 (10.7){\%} (7) and 37.0 (12.9){\%} (5), (P = 0.028). There was a statistically significant difference in outcome for patients with level 0 vs those with level >0 thrombus (P = 0.002), but there was no significant difference in outcome by thrombus level among patients with inferior vena cava tumour thrombus (P = 0.868). CONCLUSIONS: The surgical management of RCC with renal venous extension continues to develop. The incidence of early surgical complications and operative death have decreased in recent times with the introduction of improved imaging, surgical monitoring and vascular bypass techniques. There is significantly better cancer-specific survival for patients with renal vein involvement only than those with inferior vena cava involvement.",
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T1 - The Mayo-Clinic experience with surgical management complications and outcome for patients with renal cell carcinoma and venous tumour thrombus

AU - Blute, Michael L.

AU - Leibovich, Bradley C.

AU - Lohse, Christine M.

AU - Cheville, John C.

AU - Zincke, Horst

PY - 2004/7

Y1 - 2004/7

N2 - OBJECTIVE: To report the surgical management, complications and outcomes over three decades by tumour thrombus level for patients with renal cell carcinoma (RCC) and renal venous extension, as surgery is the most effective treatment. PATIENTS AND METHODS: We assessed 540 patients who underwent surgical resection for RCC with renal venous extension between 1970 and 2000. Early and late surgical complications, including operative mortality, were compared with tumour thrombus level using the chi-square, Fisher's exact and Wilcoxon rank-sum tests. Cancer-specific survival was estimated using the Kaplan-Meier method and compared across tumour thrombus levels using log-rank tests. RESULTS: There were 349 (64.6%) patients with level O thrombus and 191 (35.4%) with inferior vena cava thrombus, including 66 (12.2%) with level I, 77 (14.3%) with level II, 28 (5.2%) with level III, and 20 (3.7%) with level IV thrombus. Patients with a higher thrombus level had more early surgical complications (respectively for level 0 to IV, 8.6%, 15.2%, 14.1%, 17.9% and 30.0%, P < 0.001). However, there was no statistically significant difference in the incidence of late complications by thrombus level (P = 0.445). The incidence of any early surgical complication decreased from 13.4% for patients treated in 1970-1989 to 8.1% for those treated in 1990-2000 (P = 0.064); the respective operative mortality decreased from 3.8% to 2.0% (P = 0.260), and in patients with inferior vena cava thrombus, from 8.1% to 3.8% (P = 0.227). The respective duration of hospitalization decreased from a median of 8 to 7 days (P < 0.001) but the incidence of late complications increased significantly over time (P < 0.001.) Among patients with clear cell RCC, the respective estimated 5-year cancer-specific survival rates (SE, number still at risk) for patients with level 0 to IV thrombus were 49.1 (3.0)% (125), 31.7 (6.4)% (14), 26.3 (6.1)% (11), 39.4 (10.7)% (7) and 37.0 (12.9)% (5), (P = 0.028). There was a statistically significant difference in outcome for patients with level 0 vs those with level >0 thrombus (P = 0.002), but there was no significant difference in outcome by thrombus level among patients with inferior vena cava tumour thrombus (P = 0.868). CONCLUSIONS: The surgical management of RCC with renal venous extension continues to develop. The incidence of early surgical complications and operative death have decreased in recent times with the introduction of improved imaging, surgical monitoring and vascular bypass techniques. There is significantly better cancer-specific survival for patients with renal vein involvement only than those with inferior vena cava involvement.

AB - OBJECTIVE: To report the surgical management, complications and outcomes over three decades by tumour thrombus level for patients with renal cell carcinoma (RCC) and renal venous extension, as surgery is the most effective treatment. PATIENTS AND METHODS: We assessed 540 patients who underwent surgical resection for RCC with renal venous extension between 1970 and 2000. Early and late surgical complications, including operative mortality, were compared with tumour thrombus level using the chi-square, Fisher's exact and Wilcoxon rank-sum tests. Cancer-specific survival was estimated using the Kaplan-Meier method and compared across tumour thrombus levels using log-rank tests. RESULTS: There were 349 (64.6%) patients with level O thrombus and 191 (35.4%) with inferior vena cava thrombus, including 66 (12.2%) with level I, 77 (14.3%) with level II, 28 (5.2%) with level III, and 20 (3.7%) with level IV thrombus. Patients with a higher thrombus level had more early surgical complications (respectively for level 0 to IV, 8.6%, 15.2%, 14.1%, 17.9% and 30.0%, P < 0.001). However, there was no statistically significant difference in the incidence of late complications by thrombus level (P = 0.445). The incidence of any early surgical complication decreased from 13.4% for patients treated in 1970-1989 to 8.1% for those treated in 1990-2000 (P = 0.064); the respective operative mortality decreased from 3.8% to 2.0% (P = 0.260), and in patients with inferior vena cava thrombus, from 8.1% to 3.8% (P = 0.227). The respective duration of hospitalization decreased from a median of 8 to 7 days (P < 0.001) but the incidence of late complications increased significantly over time (P < 0.001.) Among patients with clear cell RCC, the respective estimated 5-year cancer-specific survival rates (SE, number still at risk) for patients with level 0 to IV thrombus were 49.1 (3.0)% (125), 31.7 (6.4)% (14), 26.3 (6.1)% (11), 39.4 (10.7)% (7) and 37.0 (12.9)% (5), (P = 0.028). There was a statistically significant difference in outcome for patients with level 0 vs those with level >0 thrombus (P = 0.002), but there was no significant difference in outcome by thrombus level among patients with inferior vena cava tumour thrombus (P = 0.868). CONCLUSIONS: The surgical management of RCC with renal venous extension continues to develop. The incidence of early surgical complications and operative death have decreased in recent times with the introduction of improved imaging, surgical monitoring and vascular bypass techniques. There is significantly better cancer-specific survival for patients with renal vein involvement only than those with inferior vena cava involvement.

KW - Renal cell carcinoma

KW - Surgical management and outcomes

KW - Venous tumour thrombus

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