Authors : Sujata Tripathi, Amit Kumar Mishra, Vijay C Popat, Dipak Thorve
DOI : 10.18231/j.jdpo.2020.017
Volume : 5
Issue : 1
Year : 2020
Page No : 87-92
Objective: To evaluate the experience of RCC with IVC thrombus in terms of impact of clinical and
pathological factors, level of thrombus and complications on outcome of the disease .
Materials and Methods: Seventeen patients underwent radical nephrectomy and IVC tumour
thrombectomy during 2012 to 2015 at our tertiary health care centre, clinico -pathological data from these
patients were retrospectively analysed.
Results and Discussion: Of the 17 patients (male: female: 3:1), the mean age was 57 years. The tumour
thrombus extension was level I in 58%, level II in 29%, level III in 11%. In our series, the mean blood loss
in levels I – III tumour thrombus were1863 mL, 3380 mL, 3250 ml respectively.
Clavien dindo complications were -grade I in 1 case, grade II in 7 cases, grade III in 2 cases, grade IV in
3 cases. Pathological examination demonstrated that 13 out of 17 patients had clear cell carcinoma, five
patients had higher grade(3, 4)and three had perinephric and IVC wall invasion. There was no perioperative
hospital mortality. Two patients were lost to followup, one patient died due to extensive metastatic disease
after 4 year, all other are under regular followup.
Conclusion: Radical nephrectomy with IVC thrombectomy remains a challenging procedure. Multiple
histopathological variables especially tumour stage and grade have a strong impact on the morbidity and
mortality and also help in stratifying the subgroup in which adjuvant therapy is essential. With detailed
perioperative planning and multidisciplinary efforts, surgical resection is the definitive treatment of choice
for patients of RCC with IVC tumour thrombus.
Keywords: Inferior vena cava, Renal cell carcinoma, Tumor thrombus, Complications, Radical nephrectomy.