Renal cell carcinoma with extension of tumor thrombus into the vena cava: Surgical strategy and prognosis
Renal cell carcinoma with extension of tumor thrombus into the vena cava: Surgical strategy and prognosis
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DOI：
10.1067/mva.2001.111996
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发表时间：
2001-04-01
影响因子：
4.3
通讯作者：
Kamidono, S
中科院分区：
文献类型：
--
作者：
Tsuji, Y;Goto, A;Kamidono, S
目的：方法：回顾性分析1983 ~ 1999年33例肾癌伴下腔静脉癌栓患者行根治性切除术的临床资料，分析影响肾癌伴下腔静脉癌栓患者长期生存的危险因素。男27例，女6例，平均年龄60.1岁。22例（64.7%）为III期（T1-2 N1 M0或T3 N 0 -1 M0），12例（35.3%）为IV期（T4或N2-3或M1）。肺转移7例（20.6%）。癌栓侵犯下腔静脉位于肝门以下19例，肝静脉口以下12例，膈上3例。心脏搭桥术13例（38.2%）。结果：2例患者术后早期因肝后腔静脉损伤和术中肺栓塞死亡，其中19例采用直接缝合法重建下腔静脉，13例采用聚四氟乙烯补片成形术，2例采用人工血管置换术。晚期死亡16例，死亡原因为肿瘤复发15例，移植物血栓形成导致急性肺栓塞1例。总的1年、5年和10年生存率分别为70%、44%和26.4%。III期和IV期的1年和5年生存率分别为81.3%和52.9%，50%和31.2%;手术分期与生存率之间存在统计学显著相关性（P = 0.049）。无淋巴结转移的患者比有淋巴结转移的患者具有显着的生存优势（P = 0.022）。有无同步肺转移的生存率无显著差异（P = 0.291）。肿瘤局部扩展的程度或癌栓的水平并不倾向于影响survival.Conclusions：肾细胞癌延伸到腔静脉的患者的手术预后是由肿瘤的分期，特别是淋巴结的状态，而不是由癌栓的水平或并发肺转移的存在。建议使用体外循环移植物切除延伸至膈肌的癌栓。
Purpose: The outcome of patients who underwent radical resection of renal cell carcinoma extending into the vena cava was retrospectively analyzed, and risk factors for long-term survival were investigated.Methods: From 1983 to 1999, 33 patients who had renal cell carcinoma with inferior vena caval tumor extension underwent 34 surgical procedures. There were 27 men and six women with an average age of 60.1 years. Twenty-two cases (64.7%) were classified as stage III (T1-2 N1 M0 or T3 N0-1 M0), and 12 cases (35.3%) as stage IV (T4 or N2-3 or M1). Coexistent lung metastasis was found in seven cases (20.6%). The tumor thrombi invaded into the inferior vena cava below the hepatic hilum in 19 cases, below the orifice of hepatic veins in 12, and above the diaphragm in 3. Cardiopulmonary bypass graft was applied in 13 cases (38.2%). Inferior vena cava was reconstructed by direct suture (n = 19), polytetrafluoroethylene patch angioplasty (n = 13), or graft replacement (n = 2).Results: Two patients died during the early postoperative period because of retrohepatic caval injury and intraoperative pulmonary embolism. Late death occurred in 16 patients; the causes of death were tumor recurrence in 15 and acute pulmonary embolism as a result of graft thrombosis in 1. Overall 1-, 5-, and 10-year survival rates were 70%, 44%, and 26.4%, respectively. One- and 5-year survival rates were 81.3% and 52.9% for stage III and 50% and 31.2% for stage IV; a statistically significant correlation was found between surgical staging and survival (P = .049). Patients without lymph node metastasis had a significant survival advantage over those with lymph node metastasis (P = .022). There was no significant difference in survival on the basis of the presence or absence of synchronous lung metastasis (P = .291). The degree of local extension of the tumor or the level of tumor thrombus did not tend to influence survival.Conclusions: Surgical prognosis in patients with renal cell carcinoma extending into the vena cava was determined by the staging of the tumor, especially lymph node status, and not by the level of tumor thrombus or the presence of concurrent lung metastasis. The use of cardiopulmonary bypass graft is recommended for the resection of tumor thrombus extending over the diaphragm.