Renal cell carcinoma with IVC thrombus: results and survival of 92 patients

433 RENAL CELL CARCINOMA SURVIVAL Pereverzev

WITH IVC THROMBUS:

RESULTS AND

OF 92 PATIENTS

OUTCOME OF CYTOREDUCTIVE RENAL CELL CARCINOMA

Stief C.. Matuschek I., Kuczyk M.A.. Truss MC..

Shukin Dmitry, llukhin Yuri

Alexeli,

434 LONG-TERM RECURRENT

SURGERY

FOR

iickert S., Jonas U.

Department of Urology, Hannover Medical School, Hannover, Germany Department

of

Urology.

Kharkov’s

Medical

Academy

of

Postgraduate

Education, Kharkov, Ukraine

OBJECTIVES: perioperative

INTRODUCTION

& OBJECTIVES:

Renal cell carcinoma (RCC)

extends into the inferior vena cava in 5.10%

This aim of this retrospective study was to evaluate complications and the long-term follow-up in patients with

recurrent renal cell carcinoma (RCC) after radical nephrectomy.

of cases. We examined the results

and long-term survival of patients after thrombectomy.

MATERIALS

MATERIALS

age of the patients was 64 years (47-80 years), mean follow-up period was 31 months (0.5-149 months). 40 patients presented with local recurrence, I7 with

& METHODS:

& METHODS: Between 1987 and 1999.67 patients which had undergone radical nephrectomy were diagnosed to have recurrent RCC. Mean

From 1977 until 2000. 92 patients underwent

radical nephrectomy including cavatomy and thrombectomy or caval resection. The level of tumour thrombus was assessed preoperatively

by US (65%)

MRI (35%): cavarenal segment of IVC- 19X%, infrahepatic-60.4%, 12.1%,, intrapericardial-3.3%,

atnal thrombus-4.4%.

was 24.6 months (range 3-130).

Mean

and

retrohepaic-

overall follow-up

Mean age was 65 years (range 34-78)

occurred in men in approximately

and

The rate of perioperative mortality was 4.5%.

I year survival for

patients with distant and regional metastases was 3X%, without metastasea-89%. Five-year survival in patients without metastatic lesions was 62%. The survival rate significantly

correlated with the stage of primary tumour and presence

regional and distant metastases. The differences in survival rates of the patients

RESULTS:

I patient died postoperatively and 2 developed renal insufficiency.

22 patients showed various minor complications; these complications had no influence on long-term survival (p=O.62). At the time of follow-up, I7 patients were free of disease, whereas I6 showed evidence of disease. Mean survival period was 46~8 months: 34+8 months in the group of patients with local recurrences, 42+15 months in group with lymph node metastasis, and 76+20 months in the group with contralateral renal metastasis. Mean survival after simple extirpation amounted to 55+11 months and to 25*1 I months after multivisceral extirpation. Mean survival was 63+15 months after complete (RO) and 32+8 months after incomplete (RI) resection of the tumour.

with various level of the thrombus were not demonstrated.

CONCLUSION:

thrombus. 2 other patients had a caval thrombus, 13 an infiltration of the psoas muscle. and I2 an infiltration of various organs. Median survival was estimated using the Kaplan-Meier Analysis.

two thirda of the cases (63 men and 29

women). 26% patients suffered from metaatatic disease at the time of surgery.

RESULTS:

contralateral renal turnours, and 10 with bulky lymph node metastasis. 5 of these patients had infiltration of the vena cava with 2 out of 5 presenting a caval

We believe that extended operation for renal cell carcinoma

are justified in patients without distant and regional metastases at anyone level

CONCLUSION:

Our results show that resection of recurrent RCC can be

of the tumour thrombus. The results of the surgery in this patient are not differed

accomplished with acceptable morbidity. In comparison to the historical database, surgical extirpation of recurrent RCC improved long-term outcome in

from results of the radical operations in patients without tumour invasion in IVC.

these patients.

435 CAPILLARY CHEMOEMBOLISATION IN CASES OF RENAL CELL CARCINOMA - CLINICAL EXPERIENCES OVER THE LAST 8 YEARS Seidensticker Peter’, Rassweiler Jens’ ‘Urology,

Klimkum

‘Radiology,

Klinikum

KurTidem

Markus’,

Heilbronn.

University

Heilbronn,

University

Schulze

of

Michael’,

Heidelberg,

Prager Peter’,

Heilbronn,

of Heidelberg,

Heilbronn,

Germany, Germany

shown,

that

of the procedure.

with

capillary

chemoembolisation

could

In this paper,

significantly

we want

increase

the

to focus on our clinical

ablative

used: to 7.5 ml EthibloY IO mg MitomycinC were mixed. Capillary propagation of embolic agent was guaranteed by preinjection of 40% glucose (=30% of the embolisation volume). Embolisation volume was estimated by contrast dye perfualon of the kidney. Between 1994 and 2001, 24 patients with renal cell carcinoma and the

temporary

(N=l7,

deficiency)

or absolute

postinfarction,

insufficiency)

Ethibloc”“/Mitomycin inclusions,

preceding

inoperability were

(n=7,

treated

with

C at our department.

perfusion,

tumour

size).

tumour vena

and

surgery.

cava

capillary Follow-up in

cardio-pulmonary

thrombus,

cases

cardiomyopathia.

chemoembolisation included

CT-scan

of

subsequent

I7

of

nephrectomy

in

the

cases.

Incomplete

(n=7) was mostly caused by underembolisation. Signs of a postembolic syndrome, i.e. pain, fever. hypertension and leukocytoais. here observed in 4 cases

occlusion

underembolised)

‘Department

of Interventional

‘Department

of IMR,

and can be prevented

by achieving

complete

de Jode Michael*,

Vale

Justin’,

Gedroyc

MRI,

St Marys

Hospital,

London,

United

St Marys Hospital, London, United Kingdom,

of Urology, St Marys Hospital, London, United Kingdom

INTRODUCTION

& OBJECTIVES:

To test the hypothesis that MR.guided

laser thermal ablation of inoperable renal tumours is a safe, tolerable, feasible procedure which produces significant tumour necrosis.

& METHODS:

Nine

patients (age range 56-81

years) with

malignant renal turnours underwent percutaneous laser thermal ablation (LTA) under MR guidance in a OST open magnet. Real-time colour thermal mapping monitored tumour ablation, follow-up was with gadolinium-enhanced weeks and (where appropriate)

4 monthly postprocedure

MRI at 6

intervals. Tumour

volume and percentage (c/r) viable tumour pre- and postablation (assessed by % enhancement of entire tumour volume) were compared.

RESULTS:

Average period of follow-up was 16.9 months after first ablation

(range 3-32 months). Mean pre-treatment tumour diameter was 4.3 cm (mean tumour volume 32 cm’).

seen

R&a*,

using (air bubble

of the specimen.

RESULTS: Complete tumour necrosis was

(all

Joarder

OF RENAL TUMOURS

Wladyslaw’

MATERIAL

MATERIAL & METHODS: As occlusive agent Ethibloc”” (Ethicon, Hamburg) was

histopathology

Elizabeth’.

ABLATION

experience

this technique.

cerebral

Dick

LASER THERMAL

Kingdom, ‘Department

INTRODUCTION & OBJECTIVES: Embolisation as a treatment for renal cell malignancy is a subject of controversial discussion. Open or laparoscopic radical nephrectomy should undoubtedly be the method of choice for operable renal turnours. Nevertheless elimination of a tumour-bearing kidney by embolisation of the renal artery is a minimal invasive alternative in selected cases. In earlier studies, we have efficacy

436 MR-GUIDED

arterial

occlusion.

Tumour progression after embolisation wab shown in 3 01.7 cases.

Average tumour size did not change. Average

%

enhancing tumour significantly decreased from an average of 73.7% preablation to 29.5%

postablation

(p
Signed Ranks Test). No patient

demonstrated further tumour growth locally. TIW

real time themal maps of

ablated tissue dimensions correlated closely with gadolinium-enhanced

follow-

up MRIs. There were two minor and one major complication.

CONCLUSIONS: ml/IO

mg)

Capillary

as occluding

agent

chemoembolisation is an cffcctive.

with

selected number of patlents with renal cell carcinoma realized. lrcatment.

Indications Due

Ethibloc’“/Mltomycin

minimal

invasive

if nephrectomy

are temporary

and absolute

inoperability

to the completeness

of the organ

necrosis.

syndrome has been ohuerved.

treatment

only

can

(7.5

for a not be

an well

as palliative

a mild

postrmbolic

CONCLUSIONS:

In patients unsuitable for surgery, MR guided laser thermal

ablation of renal tumours is safe, (with a complication rate comparable with other percutaneous techniques) feasible. (being well produces

significant

reduction

European

in viable

tumour

size.

Urology Supplements

tolerated

by the patient)

by an average

1 (2002)

and

of 45.5%.

No. 1, pp. 111