Dergiler / Üroloji Bülteni / 1999 / Cilt: 10 - Sayı: 3
Tümör trombüsünün eşlik ettiği renal hücreli kanserlerde cerrahi tedavi
- Dergi
- Üroloji Bülteni
- Sayfa
- 163–166
- DOI
- —
Özet
Vena kavaya tumor frombusu uzammi olan renal hucreli karsinomlu hastalardaki cerrahi tedavi sonuclarimn gozden gegirilmesi. Hastalarve Yontem: Renal hucreli karsinomu olan ve vena kavada tumor trombusu bulunan 18'i erkek, 9'u kadin toplam 27 hastaya rezeksiyon uygulandi. Ortalama hasta yasi 56.5 yil idi (40 He 76 yil arasinda). Ameliyat oncesinde 18 hastanin belirfenebilen metastazi yok iken, 9 olguda metastaz saptandi. Bulgular: Yirmi bir hastada sag bobrek, 6 hastada sol bobrek tutulmu§tu. Tumor trombusunun yayilim duzeyi 13 hastada infrahepatik, 6 hastada intrahepatik ve 8 hastada suprahepatik idi. Vena kava inferiordan trombektomi-19 hastada segmental klempleme ile, 7 hastada trombusun atriuma kadar uzanmasi nedeniyle kardiyopulmoner bypass ve derin hipotermik sirkulatuvar arrest yontemi kullanilarak yapildi. Operasyona bagli mortalite 2 hastada (% 7.4) goruldu. Tani sirasinda metastazi bulunmayan 18 hastanin 4'iJ izlem suresinde kaybedildi. Diger 14 hasta (% 77.7), ortalama 36 aylik (4 ile 101 ay arasinda) donemde hastaliksiz izlemdedir. Sonug: Vena kavaya uzanan tumor trombusu bulunan olgularda diger tedavilerle elde edilebilen basarmin du§uk olmasi, radikal nefrektomi ile birlikte kaval trombektomiyi tercih edilmesi gereken yontem konumuna getirmektedir.
Abstract
Surgical Management Of Renal Cell Carcinoma With Tumor Thrombus- Objective: To review the outcome of surgical treatment in patients with renal cell carcinoma and vena caval tumor thrombus. Patients and Methods: A total of 27 patients including 18 men and 9 women with renal cell carcinoma and vena caval tumor thrombus underwent surgical treatment. The mean patient age was 56.5 years (range; 40-76 years). While 18 patients had no detectable metastasis pre-operatively, 9 patients had metastases. Results: The tumors were on the right side in 21 patients and on the left side in 6. The extension of tumor thrombi were infrahepatic in 13, intrahepatic in 6 and suprahepatic in 8 cases. Thrombectomies from the inferior vena cava were performed by segmental clamping in 19 patients and by using cardiopulmonary bypass and deep hypothermic circulatory arrest in 7 patients who had thrombus extension into the right atrium. The operative mortality rate was 7.4 % (2 patients). Of 18 patients without distant metastasis at the time of diagnosis 4 patients died during follow up. The remaining 14 patients (% 77.7) are alive without evidence of disease in a mean follow-up of 36 months (range; 4-101 months). Conclusion: The disappointing outcome of alternative therapies justifies extensive surgery with vena caval thrombectomy in patients with renal cell carcinoma and vena caval tumor thrombus extension.