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Contemporary techniques and outcomes of surgery for locally advanced renal cell carcinoma with focus on inferior vena cava thrombectomy:The value of a multidisciplinary team

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Asian Journal of Urology 2022年第3期9卷 272-281页

作者： Riccardo Campi Paolo Barzaghi Alessio Pecoraro Maria Lucia Gallo Damiano Stracci Alberto Mariotti Saverio Giancane Simone Agostini Vincenzo Li Marzi arcangelo sebastianelli Pietro Spatafora Mauro Gacci Graziano Vignolini Francesco Sessa Paolo Muiesan Sergio Serni Unit of Urological Robotic Surgery and Renal Transplantation University of FlorenceCareggi HospitalFlorenceItaly Department of Experimental and Clinical Medicine University of FlorenceFlorenceItaly Department of Radiology Unit of UrogenitalNephrological and Kidney Transplantation ImagingCareggi HospitalUniversity of FlorenceFlorenceItaly Hepatobiliary Unit Department of Clinical and Experimental MedicineUniversity of FlorenceAOU CareggiFlorenceItaly Liver Unit Queen Elizabeth HospitalBirminghamUK

Objective:To report the outcomes of surgery for a contemporary series of patients with locally advanced non-metastatic renal cell carcinoma(RCC)treated at a referral academic centre,focusing on technical nuances and on the value of a multidisciplinary ***:We queried our prospective institutional database to identify patients undergoing surgical treatment for locally advanced(cT3-T4 N0-1 M0)renal masses suspected of RCC at our centre between January 2017 and December ***:Overall,32 patients were included in the analytic *** these,12(37.5%)tumours were staged as cT3a,8(25.0%)as cT3b,5(15.6%)as cT3c,and 7(21.9%)as cT4;6(18.8%)patients had preoperative evidence of lymph node ***(28.1%)patients underwent nephron-sparing surgery while 23(71.9%)received radical nephrectomy.A template-based lymphadenectomy was performed in 12 cases,with evidence of disease in 3(25.0%)at definitive histopathological *** cases of RCC with level IV inferior vena cava thrombosis were successfully treated using liver transplant techniques without the need for extracorporeal *** intraoperative complications were recorded in 3(9.4%)patients,no postoperative major complications(Clavien-Dindo3)were *** histopathological analysis,2(6.2%)patients who underwent partial nephrectomy harboured oncocytoma,while the most common malignant histotype was clear cell RCC(62.5%),with a median Leibovich score of 6(interquartile range 5e7).Conclusion:Locally advanced RCC is a complex and heterogenous disease posing several challenges to surgical *** experience confirms that provided careful patient selection,surgery in experienced hands can achieve favourable perioperative,oncological,and functional outcomes.

关键词： Inferior vena cava Liver transplant Open surgery Nephrectomy Renal cell carcinoma Thrombectomy

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