ABSTRACTS OF THE 21st ANNUAL MEETING OF THE ITALIAN ...

dissection of the aorta, hilum of the kidneys and the intrahepatic
VC with hepatic rotation. This maneuver exposed the
right kidney, gonodal veins, ureter, IVC, left renal vein and the
aorta. The right renal artery was ligated and cut in the cavaaortic
space. The left renal vein was completely prepared from
the IVC through the kidney. The hepatic vascular support was
also clamped. We then proceeded with incision of the IVC
until the iliac bifurcation and radical nephrectomy was then
performed, and the extended cavo-iliac thrombus was
removed. At this time, the blood flow from the iliac venal
system appeared to be low and the IVC was tied at 5 cm above
the iliac bifurcation. The operation was completed by incision
of the left renal vein, removing the thrombus with high power
flow from kidney. The vascularization of the kidney was
performed by shunt through the intra-hepatic cavo-renail vein
patch. Results: The total operation time was 3.5 hours, blood
loss was 700 cc, requiring two transfusion units. There were
no postoperative complications and the patient was discharged
ten days after this major surgery. Pathology reported renal
clear cell carcinoma, stage pt3c N0M0. Fuhram nuclear grade
IV. One-year follow-up showed the patient to be of excellent
health and metastasis free. Conclusion: The multidisciplinary
approach in this case was the best treatment for the patient
considering the clinical benefit and good prognosis for the
clinical outcome.
44
SURGICAL TREATMENT OF RENAL CELL
CARCINOMA WITH VENOUS TUMOR THROMBUS:
COMPLICATIONS AND LONG-TERM SURVIVAL
Fabiano Palmieri, Giorgio Bruno, Calogero Di Stefano,
Enza Lamanna, Michele Malizia, Remigio Pernetti and
Salvatore Voce
UO Urologia, Ospedale S. Maria delle Croci, Ravenna, Italy
Background: Renal cell carcinoma is characterized by a
marked tropism of the venous system. Involvement oftherenal
vein and inferior vena cava occurs in 23% and 7% of cases,
respectively. We present our experience with patients affected
by clear cell renal carcinoma with tumor thrombosis treated at
our department. Patients and Methods: From January 2004 to
December 2010, 253 patients underwent radical nephrectomy.
Twenty patients (8.5%) had a diagnosis of venous tumor
thrombosis. The mean patient age was 68 (range 53-97) years.
Nine patients had a renal vein thrombosis, nine had an inferior
vena cava tumor thrombus below the diaphragm and two
patients had an intrathoracic vena cava tumor thrombosis. We
evaluated the pre-, intra- and postoperative complications and
cancer-specific survival. Results: The man tumor size was 8.7
(range 4.5 to 26) cm and the length of the tumor thrombus was
7.6 (range 2.4 to 40) cm. Six patients (30%) had metastases
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ANTICANCER RESEARCH 31: 1807-1956 (2011)
at diagnosis: four patients had lung metastases, one patient had
pleural metastases and one patient had skin metastases. In nine
patients (45%), co-morbidities were present (diabetes,
hypertension, chronic renal failure) at diagnosis. Eight patients
had previously undergone abdominal surgery. Cancer-related
symptoms were diagnosed in seven patients (hematuria in four
patients, pain in one, palpable mass in one, severe fatigue and
weight loss in one patient). The mean operative time was 174
(range 90 to 255) minutes, with a mean vena cava clamping
time of 9 (range 7-18) minutes.The mean hospital stay was 11
(range 5-33) days. Estimated intraoperative blood loss was
1280 (range 200 to 4000) ml, with an average number of 2.6
(range 0-10) blood units infused intraoperatively. The
preoperative creatinine level was 1.39 (range 0.56 to 9.3)
mg/dl. Serum creatinine at admission was 1.69 (range 1 to 8.5)
mg/dl. Six patients (30%) had early complications: acute
respiratory failure (three patients), bronchopneumonia (one
patient), pleural effusion (one patient), hemoperitoneum (one
patient) that required surgery. The pathologic stage was as
follows: pT3b, 18 patients; pT3c, two patients; G2, three
patients; G3, seventeen patients; N1, two patients, N2, one
patient. The mean follow-up was 37 (range 2-72) months. The
overall cancer-specific survival was 89% at six months after
surgery, 77% at 12 months after surgery, and 33% at 48
months after surgery. Discussion and Conclusion: Our
experience shows that a significant percentage of patients
affected by renal cell carcinoma have locally advanced
disease. Surgery still remains the therapy of choice. Surgical
treatment of both renal and vena caval tumor thrombus
remains a major procedure, with a high risk of complications.
However, surgery can improve the quality of life and prolong
survival by making adjuvant therapies more effective.
1 Pouliot F, Shuch B, Larochelle JC, Pantuck A and
Belldegrun AS: Contemporary management of renal tumors
with venous tumor thrombus. J Urol 184(3): 833-841, 2010.
2 Boorjian SA and Blute ML: Surgery for vena caval tumor
extension in renal cancer. Curr Opin Urol 19(5): 473-477,
2009.
3 Karnes RJ and Blute ML: Surgery insight: management of
renal cell carcinoma with associated inferior vena cava
thrombus. Nat Clin Pract Urol 5(6): 329-339, 2008.
45
IRREVERSIBLE ELECTROPORATION, A NOVEL
TECHNIQUE FOR FOCAL ABLATION OF
PROSTATE CANCER: RESULTS OF AN INTERIM
PILOT SAFETY STUDY IN LOW-RISK PATIENTS
Maurizio Brausi 1 , Giovanni Luca Giliberto 1 ,
Gian Luca Simonini 1 , Laura Botticelli 2
and Carmela Di Gregorio 2