ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 5 of 42
УЖМБС 2020, 5(2): 43–49
Medicine. Reviews

Organ Preserving Surgical Treatment of Intravenous-Spread Kidney Tumors

Khareba G. G., Lesovoy V. N., Schukin D. V.

Organ preserving surgery for kidney tumors is gaining popularity with the purpose of preserving kidney function and avoiding comorbidities associated with kidney failure. Possible improvements in overall patient survival may be due to the ability of organ saving surgery to better preserve renal function compared to radical nephrectomy. Organ preserving surgery, as recommended, is currently contraindicated in kidney tumors at stage T3. There are currently few clinical studies comparing kidney resection and nephrectomy in the presence of venous spread. For the later stages of locally advanced kidney tumors, organ preserving surgery is not recommended, but it is becoming increasingly probable that it can be performed with results similar to those with radical nephrectomy. Patients who underwent organ preserving surgery had similar oncologic and better functional results. Therefore, a T3a kidney tumor should not be a deterrent to organ-saving surgery when technically possible to perform by qualified surgeons. In the presence of imperative indications (single kidney, neoplasm of both kidneys, chronic renal failure and others), even with the spread of the tumor into the venous bed, organ preserving surgery is considered necessary for the patient. Dialysis is associated with a large number of complications, which leads to the avoidance of the renoven condition. Cases of preserving the kidney in the course of intravenous tumor spread are very rare clinical observations. Nowadays there are only a few observations in the literature regarding organ preserving surgery in the spread of a tumor into the renal vein with conflicting results raising a number of questions about the oncological, technical, and ethical aspects of this problem, about the feasibility of organ preserving surgery. The oncological safety of such operations has not yet been demonstrated, and the purpose of preserving kidney function should not put the patient at increased risk for recurrence and progression of cancer, severe complications and death. There is very limited literature data regarding organ preserving kidney surgery with venous spread of the tumor. The article contains publications concerning organ saving surgery for intravenous kidney cancer, showing the oncological feasibility of organ saving surgery for elective or imperative indications for surgery. With a short follow-up, a low percentage of systemic progression was observed. In contrast, there is data about the negative results of such operations. The article presents the results of systematic analysis of the largest, existing series of organ preserving surgery for venous tumor spread with oncological and functional results of treatment and complications, which show that organ preserving surgery does not increase the risk of disease prolongation, recurrence and neoplasm in comparison with radical nephrectomy, but with the occurrence of more complications. It is concluded that organ preserving surgery with removal of "tumor thrombus" by imperative indications is a complicated, long-lasting operation with acceptable oncological and functional results, which may be accompanied by significant blood loss and increased risk of complications, and better preservation of renal function than in case of radical nephrectomy. On this basis, further promising large multicenter studies are needed to clarify the feasibility and the role of organ preserving surgery of renal tumors with intravenous spread in imperative indications.

Keywords: kidney tumors, organ preserving surgery, radical nephrectomy, intravenous tumor spread

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  1. Martínez-Salamanca, William C. Huang, Isabel Millán, Roberto Bertini, Fernando J. Bianco, et ll. Prognostic Impact of the 2009 UICC/AJCC TNM Staging System for Renal Cell Carcinoma with Venous Extension. European Urology. 2011; 59(1): 120-7. PMID: 20980095.
  2. Shum CF, Bahler CD, Sundaram CP. Matched Comparison Between Partial Nephrectomy and Radical Nephrectomy for T2N0M0 Tumors, a Study Based on the National Cancer Database. Journal of Endourology. 2017; 31(8); 800-5. PMID: 28486848.
  3. Janssen MWW, Linxweiler J, Terwey S, Rugge S, Ohlmann C-H, Becker F, et al. Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: Results of a multicenter cohort with long-term follow-up. PLoS ONE. 2018; 13(5): e0196427. PMID: 29723225. PMCID: PMC5933746.
  4. EAU Guidelines. Edn. presented at the EAU Annual Congress Barcelona 2019.
  5. Kopp RP, Mehrazin R, Palazzi KL, Liss MA, Jabaji R, Mirheydar HS, et al. Survival outcomes after radical and partial nephrectomy for clinical T2 renal tumours categorised by R.E.N.A.L. nephrometry score. BJU Int. 2014; 114: 708–18. PMID: 24274650.
  6. Long CJ, Canter DJ, Kutikov A, Li T, Simhan J, Smaldone M, et al. Partial nephrectomy for renal masses ≥ 7 cm: technical, oncological and functional outcomes. BJU Int. 2012; 109: 1450–6.
  7. Fero K, Hamilton ZA, Bindayi A, Murphy JD, Derweesh IH. Utilization and quality outcomes of cT1a, cT1b and cT2a partial nephrectomy: analysis of the national cancer database. BJU Int. 2018; 121: 565-74. PMID: 29032581.
  8. Hakmin Lee, Jong Jin Oh, Seok Soo Byun, Chang Wook Jeong, Cheol Kwak, Byong Chang Jeong, et al. Can partial nephrectomy provide equal oncological efficiency and safety compared with radical nephrectomy in patients with renal cell carcinoma (≥4cm)? Urologic Oncology. 2017; 35(6): 379-85. PMID: 28284894.
  9. Alanee S, Nutt M, Moore A, Holland B, Dynda D, Wilber A, et al. Partial nephrectomy for T2 renal masses: contemporary trends and oncologic efficacy. Int Urol Nephrol. 2015; 47: 945–50. PMID: 25864101.
  10. Rinott MG, Freifeld Y, Klein I, Boyarsky L, Zreik R, Orlin I, et al. Comparison of Partial and Radical Laparascopic Nephrectomy: Perioperative and Oncologic Outcomes for Clinical T2 Renal Cell Carcinoma. J Endourol. 2018; 32: 950–4.
  11. Chebbi A, Benoit T, Giwerc A, Roumiguié M, Aublé A, Doumerc N, et al. [Partial nephrectomy vs. radical nephrectomy for tumor>7cm]. Prog Urol. 2017; 27: 80–6. [French]
  12. Patel HD, Ball MW, Cohen JE, Kates M, Pierorazio PM, Allaf ME. Morbidity of urologic surgical procedures: an analysis of rates, risk factors, and outcomes. Urology. 2015; 85: 552–9. PMID: 25733265. PMCID: PMC4349385.
  13. Zini L, Perrotte P, Capitanio U, Jeldres C, Shariat SF, Antebi E, et al. Radical versus partial nephrectomy: effect on overall and noncancer mortality. Cancer. 2009; 115: 1465–71.
  14. Mir MC, Derweesh I, Porpiglia F, Zargar H, Mottrie A, Autorino R. Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1b and T2 Renal Tumors: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol. 2017; 71: 606–17. PMID: 27614693.
  15. Jeldres C, Patard JJ, Capitanio U, Perrotte P, Suardi N, Crepel M, et al. Partial versus radical nephrectomy in patients with adverse clinical or pathologic characteristics. Urology. 2009; 73: 1300-5. PMID: 19376568.
  16. Andrade HS, Zargar H, Akca O, Kara O, Caputo PA, Ramirez D, et al. Is robotic partial nephrectomy safe for T3a renal cell carcinoma? Experience of a high-volume center. J Endourol. 2017; 31: 153-7. PMID: 27881027.
  17. Abel EJ, Masterson TA, Karam JA, Master VA, Margulis V, Hutchinson R, et al. Predictive nomogram for recurrence following surgery for non-metastatic renal cell cancer with tumor thrombus. J Urol. 2017; 198: 810-6. PMID: 28411071.
  18. Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumor thrombus. BJU Int. 2004; 94: 33-41. PMID: 15217427.
  19. Arif FM, Sumida K, Molnar MZ, Potukuchi PK, Lu JL, Hassan F, et al. Early mortalty associated ‘with impatient versus outpatient hemodialysis initiation in a large cohort of US veterans with incident end-stage renal disease. Nephron. 2017; 137: 15-22. PMID: 28445893. PMCID: PMC5578898.
  20. Goodkin DA. Association of comorbid conditions and mortality in ‘hemodialysis Patients in Europe, Japan, and the United States: the dialysis outcomes and practice pattems study (DOPPS). J Am Soc Nephrol. 2003: 14: 3270-7. PMID: 14638926.
  21. Theofilow P. Quality of life in patients undergoing hemodialysis or peritoneal dialysis treatment. J Clin Med Res. 2011; 3: 132-8. PMID: 21811544. PMCID: PMC3138410.
  22. Whitson JM, Reese AC, Meng MV. Factors associated with surgery in patients with renal cell carcinoma and venous tumor thrombus. BJU Int. 2011; 107: 729-34. PMID: 20880195.
  23. Sengupta S, Zincke H, Leibovich BC, Blute ML. Surgical treatment of stage pT3b renal cell carcinoma in solitary kidneys: a case series. BIU Int. 2005: 96: 54-7. PMID: 15963120.
  24. Woldu SL, Barlow LJ, Patel T, Hruby GW, Benson MC, MeKiernan JM. Single institutional experience with nephron-sparing surgery for pathologic stage T3bNxMO renal cell carcinoma confined to the renal vein. Urology. 2010: 76: 639-42. PMID: 20163841.
  25. Angermeier KW, Novick AC, Streem SB, Montie JE. Nephron-sparing surgery for renal cell carcinoma with venous involvement. J Urol. 1990; 144: 1352-5.
  26. Allaf ME, Gorin MA. Editorial comment. Urology. 2013; 81: 1367. PMID: 23522999.
  27. Tollefson MK, Kawashima A, Blute ML. In situ partial nephrectomy and tumor thrombectomy for renal cell carcinoma with level I vena cava extension in a solitary kidney. Urology. 2005; 66: 882. PMID: 16230173.
  28. Pruthi RS, Angell SK, Brooks JD. Gill H. Partial nephrectomy and caval thrombectomy for renal cell carcinoma in a solitary kidney with an accessory renal vein. BJU Int. 1999; 83: 142-3. PMID: 10233469.
  29. Marra G, Gontero P, Brattoli M, Filippini C, Capitanio U, Montorsi F, et all. Is imperative partial nephrectomy feasible for kidney cancer with venous thrombus involvement? Outcomes of 42 cases and matched pair analysis with large radical nephrectomy cohort. Urologic Oncology. 2018; 36(7): 39.e1-339.e8. PMID: 29801993.
  30. Abaza_R, Angell J. Robotic partial nephrectomy for renal cell carcinomas with venous tumor thrombus. Urology. 2013: 81: 1362-7. PMID: 23522996.
  31. Toren P, Abouassaly R, Timilshina N, Kulkami G, Alibhai S, Finelli A. Results of national population-based study of outcomes of surgery for renal tumors associated with inferior vena cava thrombus. Urology. 2013: 82: 572-7. PMID: 23987150.