ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2021 December;73(6):746-53

DOI: 10.23736/S2724-6051.20.03844-8

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 LUCIANO 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 Hospital, Milan, Italy; ² Unit of Urology, Division of Experimental Oncology, 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, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy; ⁵ Unit of Hepatobiliary Surgery, Department of General Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy; ⁶ Unit of Radiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy; ⁷ Unit of Anesthesiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy

BACKGROUND: Scarce data are available regarding the technique and outcomes for patients with RCC and Mayo III caval thrombi. The aim of this study was 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 maneuver (PM).
METHODS: Retrospective analysis of surgical technique, outcomes and cancer control in 19 patients undergoing LM and PM in a single tertiary care institution were analyzed.
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 complications 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%. Two-year 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: Thrombectomy; Carcinoma, renal cell; Liver