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Arie S Belldegrun - One of the best experts on this subject based on the ideXlab platform.
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contemporary management of renal Tumors with venous Tumor Thrombus
The Journal of Urology, 2010Co-Authors: Frederic Pouliot, Brian Shuch, Jeffrey Larochelle, Allan J Pantuck, Arie S BelldegrunAbstract:Purpose: Renal cell carcinoma with intravenous Tumor Thrombus remains one of the most intriguing and challenging topics in urological oncology. With better understanding of the biology of intravascular Tumor invasion and improvements in overall survival, the surgical and medical treatment of these patients is being completely redefined.Materials and Methods: We performed a MEDLINE® search for relevant articles on renal cell carcinoma with intravenous Tumor Thrombus.Results: We describe the staging systems, prognostic factors and surgical techniques involved in the management of renal cell carcinoma with intravenous Tumor Thrombus. We also review long-term survival of local, advanced and metastatic renal cell carcinoma with Tumor Thrombus invasion. Finally, we propose a clinical algorithm for the treatment of patients with renal cell carcinoma invading the venous system.Conclusions: Management of a kidney cancer Tumor invading the venous system should now consider the primary biology and natural behavior o...
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prognostic factors for renal cell carcinoma with Tumor Thrombus extension
The Journal of Urology, 2007Co-Authors: Tobias Klatte, Brian Shuch, Allan J Pantuck, Stephen B Riggs, Mark D Kleid, Nazy Zomorodian, Fairooz F Kabbinavar, Arie S BelldegrunAbstract:Purpose: We identified prognostic factors for renal cell carcinoma with Tumor Thrombus extension and assessed whether the current T3 classification could be improved.Materials and Methods: We studied clinicopathological parameters in 321 consecutive patients who were surgically treated for renal cell carcinoma with Tumor Thrombus extension. Disease specific survival was evaluated with univariate and multivariate analysis. Harrell’s C-index was used to assess the prognostic accuracy of prognostic models.Results: Tumor Thrombus extended into the renal vein in 166 patients, the inferior vena cava in 137 and the atrium in 18. Metastatic renal cell carcinoma was found in 198 patients (62%). The Thrombus level had no impact on clinicopathological parameters or survival but perioperative morbidity and mortality increased with cranial extension of the Thrombus. Mean followup was 49 months. Five and 10-year disease specific survival rates were 36% and 24%, respectively. On multivariate analysis Eastern Cooperative...
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renal cell carcinoma with Tumor Thrombus extension biology role of nephrectomy and response to immunotherapy
The Journal of Urology, 2003Co-Authors: Amnon Zisman, Allan J Pantuck, Jeff A Wieder, Debby H Chao, Frederick J Dorey, Jonathan W Said, Barbara J Gitlitz, Jean B De Kernion, Robert A Figlin, Arie S BelldegrunAbstract:ABSTRACTPurpose: We outline the biology, prognosis and role of immunotherapy for renal cell carcinoma with gross venous Tumor Thrombus.Materials and Methods: A total of 207 patients with unilateral renal cell carcinoma and Tumor Thrombus into the renal vein (107) and inferior vena cava (100) who underwent nephrectomy and thrombectomy were compared with 607 without Tumor Thrombus.Results: At diagnosis 77 patients (37%) had N0M0 disease and 130 (63%) had lymph node (N+) or distant (M1) metastases. Compared with nonTumor Thrombus cases Tumor Thrombus was associated with more advanced stage, N+ (26% versus 12%), M1 (54% versus 31%) disease, higher grade and Eastern Cooperative Oncology Group performance status. In N0M0 cases with inferior vena caval Tumor Thrombus capsular penetration, collecting system invasion and extension into the hepatic vein were more important prognostic variables then the level of inferior vena caval Thrombus. In patients with confined N0M0 Tumors mean 2 and 5-year survival ± SD was 8...
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renal cell carcinoma with Tumor Thrombus is cytoreductive nephrectomy for advanced disease associated with an increased complication rate
The Journal of Urology, 2002Co-Authors: Amnon Zisman, Allan J Pantuck, Jeff A Wieder, Debby H Chao, Frederick J Dorey, Jonathan W Said, Jean B De Kernion, Robert A Figlin, Arie S BelldegrunAbstract:ABSTRACTPurpose: We examined whether cytoreductive nephrectomy in patients with venous Tumor Thrombus and metastatic disease is associated with more complications than in those with Thrombus without metastatic disease.Materials and Methods: Between 1989 and 2000, 74 patients with renal vein extension, 87 with inferior vena caval extension and 491 without Tumor Thrombus underwent nephrectomy at our institution. Metastatic and nonmetastatic renal vein extension in 51 and 23 cases, inferior vena caval extension in 54 and 33, and nonTumor Thrombus in 171 and 320, respectively, were compared for symptoms at presentation, surgical data, mortality and complications.Results: For nonmetastatic and metastatic inferior vena caval extension presenting symptoms, hospital stay, surgical time and the number of patients undergoing thoraco-abdominal incision, lymph node dissection, venacavotomy alone for Thrombus and adrenal sparing surgery were similar. Five patients with Thrombus died intraoperatively or postoperatively...
Shinji Uemoto - One of the best experts on this subject based on the ideXlab platform.
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proposal of selection criteria for operative resection of hepatocellular carcinoma with inferior vena cava Tumor Thrombus incorporating hepatic arterial infusion chemotherapy
Surgery, 2017Co-Authors: Yosuke Kasai, Etsuro Hatano, Hideaki Okajima, Kentaro Yasuchika, Kojiro Taura, Toshimi Kaido, Shinji UemotoAbstract:Background Because operative resection of hepatocellular carcinoma with inferior vena cava Tumor Thrombus has been associated with a substantial risk of recurrence and postoperative morbidity, adequate patient selection for resection is necessary. Our aim was to propose selection criteria for resection of hepatocellular carcinoma with inferior vena cava Tumor Thrombus. Methods Long-term outcomes were analyzed retrospectively in 39 operative cases of hepatocellular carcinoma with inferior vena cava Tumor Thrombus (1996–2015). Since 2003, preoperative hepatic arterial infusion chemotherapy instead of immediate resection has been performed in patients with advanced inferior vena cava Tumor Thrombus, defined as those patients with suspected extrahepatic metastasis, who will need extracorporeal circulation, or who have marginal liver function and/or multiple bilobar Tumors. Indication for resection has been based on the Tumor response to hepatic arterial infusion chemotherapy thereafter. Results The median survival time for all patients was 15.2 months. Multivariate analysis revealed that preoperative hepatic arterial infusion chemotherapy (hazard ratio: 0.30), use of extracorporeal circulation (3.12), and extrahepatic metastasis (2.67) were independent prognostic factors for overall survival. Among patients with initially advanced inferior vena cava Tumor Thrombus, preoperative hepatic arterial infusion chemotherapy was associated with a much more favorable prognosis compared with no hepatic arterial infusion chemotherapy (median survival time: unreached vs 8.3 months, P = .007). Overall survival was significantly worse in patients with uncontrolled, advanced inferior vena cava Tumor Thrombus than in those without advanced inferior vena cava Tumor Thrombus or with advanced inferior vena cava Tumor Thrombus controlled by preoperative hepatic arterial infusion chemotherapy (median survival time: 10.4 vs 26.1 months, P = .039). Conclusion An effective response to hepatic arterial infusion chemotherapy and subsequent operative resection salvaged patients with initially advanced inferior vena cava Tumor Thrombus. Our results suggest that operative resection should be indicated only in patients without advanced inferior vena cava Tumor Thrombus or with advanced inferior vena cava Tumor Thrombus controlled by preoperative hepatic arterial infusion chemotherapy.
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Mass-forming intrahepatic cholangiocarcinoma with portal vein Tumor Thrombus and bile duct Tumor Thrombus: A case report.
International Journal of Surgery Case Reports, 2017Co-Authors: Kentaro Iwaki, Kojiro Taura, Toshimi Kaido, Yamamoto, Naoko Kamo, Shintaro Yagi, Shinji UemotoAbstract:Abstract Introduction We report the first case of mass-forming intrahepatic cholangiocarcinoma (ICC) with portal vein Tumor Thrombus (PVTT) and bile duct Tumor Thrombus (BDTT), where the extrahepatic bile duct was preserved with thrombectomy. Presentation of case A 70-year-old male. Magnetic resonance imaging (MRI) showed the Tumor extending from the hepatic hilum to the left hepatic duct with complete obstruction of the left hepatic duct and a defect at the left portal vein. We planned to perform extended left lobectomy, lymph node dissection, extra hepatic bile duct resection and reconstruction based on the diagnosis of mass-forming ICC with left portal vein and left hepatic duct infiltration (cT3N0M0 Stage III). Intraoperative cholangiography revealed a crab claw-like filling defect at the left hepatic duct, which suggested Tumor Thrombus. Accordingly, we performed thrombectomy. The margin of the left hepatic duct was Tumor negative, so we performed extended left lobectomy, lymph node dissection and thrombectomy. Pathologically, the Tumor was diagnosed as ICC (pT4N0M0 Stage IVA, vp3, b3). Tumors in the left hepatic duct and left portal vein proved to be Tumor Thrombus. The postoperative course was uneventful. He is doing well without recurrence. Discussion Thrombectomy is performed for hepatocellular carcinoma (HCC) with Tumor Thrombus. Furthermore, extrahepatic bile duct resection and reconstruction are recommended for ICC. In this case, intraoperative cholangiography was effective for precisely diagnosing. Thrombectomy could reduce surgical stress and prevent complications. Conclusions Thrombectomy can be a valid option for ICC with Tumor Thrombus, as well as for HCC.
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hepatic resection for hepatocellular carcinoma with Tumor Thrombus in the major portal vein
Digestive Surgery, 2015Co-Authors: Hidenobu Kojima, Etsuro Hatano, Kentaro Yasuchika, Kojiro Taura, Satoru Seo, Shinji UemotoAbstract:Background: The prognosis of hepatocellular carcinoma (HCC) with Tumor Thrombus in the major portal vein has been extremely poor. We investigated the outcome of h
Bradley C Leibovich - One of the best experts on this subject based on the ideXlab platform.
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surgical management and oncologic outcomes of recurrent venous Tumor Thrombus after prior nephrectomy for renal cell carcinoma
European urology focus, 2016Co-Authors: William P Parker, Stephen A Boorjian, Harras B Zaid, John C Cheville, Bradley C Leibovich, Houston R ThompsonAbstract:Abstract Background While the management of a venous Tumor Thrombus in renal cell carcinoma is well described, there is a paucity of evidence to guide care in patients who recur within the vena cava. Objective To report our experience with patients presenting with recurrent venous Tumor thrombi after prior radical nephrectomy. Design, setting, and participants A retrospective review of 16 patients from 1970 to 2013 with a history of renal cell carcinoma treated surgically for a recurrent Tumor Thrombus unrelated to a new renal Tumor. Intervention Recurrent Tumor thrombectomy. Outcome measurements and statistical analysis Intraoperative outcomes, recurrence-free survival, and cancer-specific survival following resection. Results and limitations Of the 16 patients, three patients were diagnosed with synchronous widely metastatic disease, did not undergo recurrent Tumor thrombectomy, and died within 6 mo. Among the remaining 13 repeat surgical patients, the median age was 67 (range: 48–76) yr with a median time from prior nephrectomy to diagnosis of 6 (range: 3–58) mo. Nine patients had known Tumor Thrombus at nephrectomy, all of whom were thought to have complete Tumor thrombectomy at initial surgery. During exploration for recurrent Thrombus, surgical resection was completed in 11, with a median blood loss of 2500 (range: 200–7000) ml, and a median transfusion requirement of four (range: 0–18) units. At a median follow-up of 12 mo all patients had recurred and died of disease. The median time to recurrence and death was 4 mo and 12 mo following repeat exploration, respectively. Conclusions Recurrent Tumor thrombectomy is a technically feasible yet challenging operation. Survival is poor in this population with metastatic progression appreciated in all patients in our series. Patient summary In this report we evaluated outcomes for patients presenting with vena cava Tumor Thrombus after prior nephrectomy for renal cell carcinoma. We found that surgical excision is complex yet feasible and that survival following resection was poor.
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management of inferior vena cava Tumor Thrombus in locally advanced renal cell carcinoma
Therapeutic Advances in Urology, 2015Co-Authors: Sarah P Psutka, Bradley C LeibovichAbstract:The diagnosis of renal cell carcinoma is accompanied by intravascular Tumor Thrombus in up to 10% of cases, of which nearly one-third of patients also have concurrent metastatic disease. Surgical resection in the form of radical nephrectomy and caval thrombectomy represents the only option to obtain local control of the disease and is associated with durable oncologic control in approximately half of these patients. The objective of this clinical review is to outline the preoperative evaluation for, and operative management of patients with locally advanced renal cell carcinoma with venous Tumor thrombi involving the inferior vena cava. Cornerstones of the management of these complex patients include obtaining high-quality imaging to characterize the renal mass and Tumor Thrombus preoperatively, with further intraoperative real-time evaluation using transesophageal echocardiography, careful surgical planning, and a multidisciplinary approach. Operative management of patients with high-level caval thrombi should be undertaken in high-volume centers by surgical teams with capacity for bypass and invasive intraoperative monitoring. In patients with metastatic disease at presentation, cytoreductive nephrectomy and Tumor thrombectomy may be safely performed with simultaneous metastasectomy if possible. In the absence of level one evidence, neoadjuvant targeted therapy should continue to be viewed as experimental and should be employed under the auspices of a clinical trial. However, in patients with significant risk factors for postoperative complications and mortality, and especially in those with metastatic disease, consultation with medical oncology and frontline targeted therapy may be considered.
Allan J Pantuck - One of the best experts on this subject based on the ideXlab platform.
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contemporary management of renal Tumors with venous Tumor Thrombus
The Journal of Urology, 2010Co-Authors: Frederic Pouliot, Brian Shuch, Jeffrey Larochelle, Allan J Pantuck, Arie S BelldegrunAbstract:Purpose: Renal cell carcinoma with intravenous Tumor Thrombus remains one of the most intriguing and challenging topics in urological oncology. With better understanding of the biology of intravascular Tumor invasion and improvements in overall survival, the surgical and medical treatment of these patients is being completely redefined.Materials and Methods: We performed a MEDLINE® search for relevant articles on renal cell carcinoma with intravenous Tumor Thrombus.Results: We describe the staging systems, prognostic factors and surgical techniques involved in the management of renal cell carcinoma with intravenous Tumor Thrombus. We also review long-term survival of local, advanced and metastatic renal cell carcinoma with Tumor Thrombus invasion. Finally, we propose a clinical algorithm for the treatment of patients with renal cell carcinoma invading the venous system.Conclusions: Management of a kidney cancer Tumor invading the venous system should now consider the primary biology and natural behavior o...
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prognostic factors for renal cell carcinoma with Tumor Thrombus extension
The Journal of Urology, 2007Co-Authors: Tobias Klatte, Brian Shuch, Allan J Pantuck, Stephen B Riggs, Mark D Kleid, Nazy Zomorodian, Fairooz F Kabbinavar, Arie S BelldegrunAbstract:Purpose: We identified prognostic factors for renal cell carcinoma with Tumor Thrombus extension and assessed whether the current T3 classification could be improved.Materials and Methods: We studied clinicopathological parameters in 321 consecutive patients who were surgically treated for renal cell carcinoma with Tumor Thrombus extension. Disease specific survival was evaluated with univariate and multivariate analysis. Harrell’s C-index was used to assess the prognostic accuracy of prognostic models.Results: Tumor Thrombus extended into the renal vein in 166 patients, the inferior vena cava in 137 and the atrium in 18. Metastatic renal cell carcinoma was found in 198 patients (62%). The Thrombus level had no impact on clinicopathological parameters or survival but perioperative morbidity and mortality increased with cranial extension of the Thrombus. Mean followup was 49 months. Five and 10-year disease specific survival rates were 36% and 24%, respectively. On multivariate analysis Eastern Cooperative...
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renal cell carcinoma with Tumor Thrombus extension biology role of nephrectomy and response to immunotherapy
The Journal of Urology, 2003Co-Authors: Amnon Zisman, Allan J Pantuck, Jeff A Wieder, Debby H Chao, Frederick J Dorey, Jonathan W Said, Barbara J Gitlitz, Jean B De Kernion, Robert A Figlin, Arie S BelldegrunAbstract:ABSTRACTPurpose: We outline the biology, prognosis and role of immunotherapy for renal cell carcinoma with gross venous Tumor Thrombus.Materials and Methods: A total of 207 patients with unilateral renal cell carcinoma and Tumor Thrombus into the renal vein (107) and inferior vena cava (100) who underwent nephrectomy and thrombectomy were compared with 607 without Tumor Thrombus.Results: At diagnosis 77 patients (37%) had N0M0 disease and 130 (63%) had lymph node (N+) or distant (M1) metastases. Compared with nonTumor Thrombus cases Tumor Thrombus was associated with more advanced stage, N+ (26% versus 12%), M1 (54% versus 31%) disease, higher grade and Eastern Cooperative Oncology Group performance status. In N0M0 cases with inferior vena caval Tumor Thrombus capsular penetration, collecting system invasion and extension into the hepatic vein were more important prognostic variables then the level of inferior vena caval Thrombus. In patients with confined N0M0 Tumors mean 2 and 5-year survival ± SD was 8...
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renal cell carcinoma with Tumor Thrombus is cytoreductive nephrectomy for advanced disease associated with an increased complication rate
The Journal of Urology, 2002Co-Authors: Amnon Zisman, Allan J Pantuck, Jeff A Wieder, Debby H Chao, Frederick J Dorey, Jonathan W Said, Jean B De Kernion, Robert A Figlin, Arie S BelldegrunAbstract:ABSTRACTPurpose: We examined whether cytoreductive nephrectomy in patients with venous Tumor Thrombus and metastatic disease is associated with more complications than in those with Thrombus without metastatic disease.Materials and Methods: Between 1989 and 2000, 74 patients with renal vein extension, 87 with inferior vena caval extension and 491 without Tumor Thrombus underwent nephrectomy at our institution. Metastatic and nonmetastatic renal vein extension in 51 and 23 cases, inferior vena caval extension in 54 and 33, and nonTumor Thrombus in 171 and 320, respectively, were compared for symptoms at presentation, surgical data, mortality and complications.Results: For nonmetastatic and metastatic inferior vena caval extension presenting symptoms, hospital stay, surgical time and the number of patients undergoing thoraco-abdominal incision, lymph node dissection, venacavotomy alone for Thrombus and adrenal sparing surgery were similar. Five patients with Thrombus died intraoperatively or postoperatively...
Brian Shuch - One of the best experts on this subject based on the ideXlab platform.
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clinical management of renal cell carcinoma with venous Tumor Thrombus
World Journal of Urology, 2014Co-Authors: Nnenaya Q Agochukwu, Brian ShuchAbstract:Objectives Venous invasion is common in advanced renal cell carcinoma (RCC) due to the unique biology of this cancer. The presence of a Tumor Thrombus often makes clinical management challenging. In this review, we detail specific preoperative, perioperative, and surgical strategies involving the care of the complex kidney cancer patient with venous Tumor involvement.
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contemporary management of renal Tumors with venous Tumor Thrombus
The Journal of Urology, 2010Co-Authors: Frederic Pouliot, Brian Shuch, Jeffrey Larochelle, Allan J Pantuck, Arie S BelldegrunAbstract:Purpose: Renal cell carcinoma with intravenous Tumor Thrombus remains one of the most intriguing and challenging topics in urological oncology. With better understanding of the biology of intravascular Tumor invasion and improvements in overall survival, the surgical and medical treatment of these patients is being completely redefined.Materials and Methods: We performed a MEDLINE® search for relevant articles on renal cell carcinoma with intravenous Tumor Thrombus.Results: We describe the staging systems, prognostic factors and surgical techniques involved in the management of renal cell carcinoma with intravenous Tumor Thrombus. We also review long-term survival of local, advanced and metastatic renal cell carcinoma with Tumor Thrombus invasion. Finally, we propose a clinical algorithm for the treatment of patients with renal cell carcinoma invading the venous system.Conclusions: Management of a kidney cancer Tumor invading the venous system should now consider the primary biology and natural behavior o...
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prognostic factors for renal cell carcinoma with Tumor Thrombus extension
The Journal of Urology, 2007Co-Authors: Tobias Klatte, Brian Shuch, Allan J Pantuck, Stephen B Riggs, Mark D Kleid, Nazy Zomorodian, Fairooz F Kabbinavar, Arie S BelldegrunAbstract:Purpose: We identified prognostic factors for renal cell carcinoma with Tumor Thrombus extension and assessed whether the current T3 classification could be improved.Materials and Methods: We studied clinicopathological parameters in 321 consecutive patients who were surgically treated for renal cell carcinoma with Tumor Thrombus extension. Disease specific survival was evaluated with univariate and multivariate analysis. Harrell’s C-index was used to assess the prognostic accuracy of prognostic models.Results: Tumor Thrombus extended into the renal vein in 166 patients, the inferior vena cava in 137 and the atrium in 18. Metastatic renal cell carcinoma was found in 198 patients (62%). The Thrombus level had no impact on clinicopathological parameters or survival but perioperative morbidity and mortality increased with cranial extension of the Thrombus. Mean followup was 49 months. Five and 10-year disease specific survival rates were 36% and 24%, respectively. On multivariate analysis Eastern Cooperative...
