Minerva Urologica e Nefrologica 2020 Nov 27

DOI: 10.23736/S0393-2249.20.03844-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Perioperative and oncologic outcomes of open radical nephrectomy and inferior vena cava thrombectomy with liver mobilization and Pringle maneuver for Mayo III level tumor thrombus: single institution experience

Alessandro NINI ^{1, 2, 3}, Fabio MUTTIN ^{1, 2}, Francesco CIANFLONE ^{1, 2}, Cristina CARENZI ^{1, 2}, Roberta LUCIANÓ ⁴, Marco CATENA ⁵, Alessandro LARCHER ^{1, 2}, Marco SALVIONI ⁶, Walter CAZZANIGA ^{1, 2}, Filippo PEDERZOLI ^{1, 2}, Rayan MATLOOB ^{1, 2}, Renzo COLOMBO ^{1, 2}, Michele PAGANELLI ⁵, Andrea SALONIA ^{1, 2}, Alberto BRIGANTI ^{1, 2}, Claudio DOGLIONI ⁴, Alberto ZANGRILLO ⁷, Francesco DE COBELLI ⁶, Patrizio RIGATTI ^{1, 2}, Massimo FRESCHI ⁴, Guglielmo CORNERO ⁷, Roberto NICOLETTI ⁶, Luca ALDRIGHETTI ⁵, Francesco MONTORSI ^{1, 2}, Umberto CAPITANIO ^{1, 2}, Roberto BERTINI ^{1, 2} ✉

¹ Department of Urology, IRCCS, San Raffaele Scientific Institute, Milan, Italy; ² Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy; ³ Department of Urology and Pediatric Urology, Saarland University Medical Center, Saarland University, Homburg, Germany; ⁴ Unit of Pathology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; ⁵ Unit of Hepatobiliary Surgery, Department General Surgery, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; ⁶ Unit of Radiology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; ⁷ Unit of Anesthesiology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy

BACKGROUND: Scarce data are available regarding the technique and outcomes for patients with RCC and Mayo III caval thrombi. To report surgical and oncological outcomes of RCC patients with Mayo III thrombi treated with radical nephrectomy and thrombectomy after liver mobilization (LM) and Pringle Manoeuvre (PM).
METHODS: Retrospective analysis of surgical technique, outcomes and cancer control in 19 patients undergoing LM and PM in a single tertiary care institution.
RESULTS: Overall, 78% of the patients had performance status ECOG 1 and 58% had a comorbidity index >2. Median surgical time was 305 minutes (IQR 264-440). Intraoperative complications were reported for 39% of patients and postoperative ones for 58% (only Grade 1 and 2). Intensive Care Unit support was necessary in 16% of the cases. Median length of hospital stay was 9 days (IQR 7-11). Thirty- and 90-day mortality were 5% and 15%. Twoyear overall survival and cancer-specific survival were 60% and 62%, respectively.
CONCLUSIONS: We reported surgical techniques, intra and perioperative complications and follow-up in the largest cohort of RCC patients requiring LM and PM.

KEY WORDS: Renal cell carcinoma; Caval thrombectomy; Liver derotation; Pringle manoeuvre