AUA 2018: Oncological and Functional Outcomes in Minimally Invasive Approach for Kidney Cancer with Venous Thrombus

San Francisco, CA ( In case of localized kidney cancer (KC) without venous thrombus (VT) minimally invasive (MI) procedure is commonly used. However little evidence exists on the usage of this approach for the treatment of KC with VT.  A multicenter cohort of 2245 patients was analyzed. A total of 120 patients who underwent an MI approach with a diagnosis of KC + VT (T stage >=3a), were included in the analysis.

One hundred and ten procedures were laparoscopic whilst 10 were robotic. Primary outcomes were cancer specific survival (CSS), overall survival (OS) and post-operative renal function, evaluated through serum creatinine levels (sCr) and eGFR. Complications were graded using the Clavien-dindo classification and comorbidities with ASA score. Thrombus level was recorded according to the Mayo Clinic Classification. 

Mean Pre-operative eGFR was 77.93 (30.6) mL/min. 50.98% had an ASA score of 2. Mean tumor size was 6.8 (2.57) cm, 7.89% were N+ and 13.33% M+. Thrombus level in 94.53% of the patients was confined to the renal vein (level 1). Mean operating time was 197.05 (88.35) min with a mean blood loss of 682.37 (2156.61)mL. In 14.42% and 6.73% of patients, lymphadenectomy and cavotomy were performed respectively, while 1.11% needed a cardiopulmonary bypass. Major complications (Clavien >=3) occurred in 24.8% of patients with no intraoperative deaths. Mean hospital stay was 7.97 (8.50) days. After a mean follow up of 935.33 (862.14) days, CSS was 75.85% and OS was 72.65% with 80.26% of the patients being free of recurrence, 7.89% having disease progression and 11.84% having stable disease. 

The authors concluded that in KC + VT MI surgery may be feasible yielding acceptable oncological and functional outcomes. However, blood loss, hospital stay and high grade complications remain relatively high. Further large prospective studies are needed to evaluate the role of MI surgery for KC + VT.

Presented by: Giancarlo Marra, Turin, Italy
Co-Authors: Francesco Soria, Michele Brattoli, Claudia Filippini, Turin, Italy, Estefania Linares Espinos, Juan Martinez Salamanca, Madrid, Spain, Martin Sphan, Bern, Switzerland, Douglas S. Scherr, Ithaca, NY, Francisco Delgado-Oliva, César David Vera-Donoso, Valencia, Spain, Adam C. Lorentz, Master Viraj, Atlanta, GA, James Mckiernan, New York, NY, John A. Libertino, Boston, MA, William C. Huang, New York, NY, Christopher Evans, Sacramento, CA, Umberto Capitanio, Francesco Montorsi, Milan, Italy, Georg Hutterer, Francisco Soria, Richard Zigeuner, Graz, Germany, Paolo Gontero, Turin, Italy

Written by:  Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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