Carcinoma de Células Renais com Envolvimento Venoso

 

Sérgio Pereira*, David Martinho*, Tiago Mendonça*, Ruy Fernandes**, Helena Correia*, Luís Mendes Pedro**, A. Dinis da Gama**, Tomé Lopes*

* Serviço de Urologia

** Clínica Universitária de Cirurgia Vascular Hospital de Santa Maria Centro Hospitalar Lisboa Norte, E.P.E.

Correspondência

 

|RESUMO|

Introdução: O Carcinoma de Células Renais (CCR) representa 3% das neoplasias em adultos. É uma das neoplasias urológicas mais letais, com uma mortalidade específica de 40%. A invasão parietal ou a presença de trombo tumoral na veia cava inferior acontece em 4% a 10% dos doentes (= T3b) com sobrevida estimada aos cinco anos entre 40% e 60%. A única estratégia curativa é a exérese em bloco do trombo tumoral e do rim.

Material e Métodos: Avaliámos retrospectivamente os processos clínicos, incluindo dados imagiológicos e histopatológicos, de todos os doentes com CCR submetidos a nefrectomia radical entre 2008 e 2009 na nossa instituição.

Resultados: Foi identificado o envolvimento venoso em 10,1% dos doentes (sete em 69), com idade média de 58 anos (32-72). Seis (85,7%) apresentavam invasão da veia renal, quatro (57,1%) trombo tumoral na veia renal e 3 (42,9%) trombo tumoral na veia cava (dois no nível II e um no nível I). A três destes doentes foi realizada cavotomia com excisão do trombo, sem complicações. Um doente abandonou o seguimento médico; dois doentes faleceram no pós-operatório imediato ou precoce (três a sete dias); um doente faleceu por progressão da doença sistémica; os restantes três apresentam progressão da doença.

Conclusões: O CCR acompanhado por trombo tumoral na veia cava apresenta uma história natural pouco favorável, mas que pode ser drasticamente alterada se a atitude cirúrgica for agressiva e completa. A constituição de equipas multidisciplinares é fundamental.

Palavras-chave: Carcinoma de células renais, veia cava,

 

Renal Cell Carcinoma with Venous Involvement

|ABSTRACT|

Introduction: Renal Cell Carcinoma (RCC) accounts for 3% of adult carcinomas. It is one of the most deadly urological cancers with disease specific mortality of 40%. Venous wall invasion or tumor thrombus is seen in 4% to 10% of patients (= T3b), with 5 years survival from 40% to 60%. The only curative treatment is tumor thrombus and kidney en bloc removal.

Materials and Methods: All the clinical, radiological and pathological data of the patients submitted to radical nephrectomy at our institution through 2008 and 2009 was reviewed.

Results: We found venous involvement in seven of the 69 patients (10,1%). Average age was 58 years (32-72); Six patients (85,7%) had renal vein invasion; four (57,1%) had renal vein thrombus and three (42,9%) had cava vein thrombus (two at level II and one at level III). Three were submitted to cavotomy with no complications. One was lost to follow-up; two died on early post-op (three to seven days); one died due to systemic disease progression; the other three have disease progression.

Conclusions: RCC with vena cava involvement has a poor natural history, but this can be dramatically changed with an aggressive and complete surgical attitude. For that means, multidisciplinary teams are mandatory.

Key words: Renal cell carcinoma, vena cava

 

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BIBLIOGRAFIA

^[1] Börje Ljungberg, et al; EAU Guidelines on Renal Cell Carcinoma: The 2010 Update; European Urology 58 (2010) 398-406

^[2] Wein, Kavoussi, Novick, Partin, Peters; Campbell-Walsh Urology 9th ed; 2007; Saunders

^[3] Fernando Alonso, et al; Renal cell carcinooma with vana cava involvement: update and review of our series; Actas Urológicas Españolas 2009; 33 (5): 569-74

^[3] S H Landis, et al; Cancer statistics; CA Cancer J Clin; 1999; 49 (1): 8-31        [ Links ]

^[4] J Ferlay, et al; Estimates of the câncer incidence and mortality in Europe in 2006; Ann Oncol 2007 Mar; 18 (3): 581-92

^[5] L Lipworth, et al; The epidemiology of renal cell carcinoma. J Urol 2006; Dec; 176 (6 Pt 1): 2353-8

^[6] W H Chow, et al; Rising incidence of renal cell câncer in the United States; JAMA 1999; 281: 1628-1631

^[7] C T Lee, et al; Mode of presentation of renal cell carcinoma provides prognostic information; Urol Oncol 2002 Jul-Aug;7(4):135-40

^[8] J J Patard, et al; Correlation between symptom graduation, tumor characteristics and survival in renal cell carcinoma; Eur Urol 2003 Aug;44(2):226-32

^[9] C J Kane, et al; Renal cell cancer stage migration: analysis of the National Cancer Data Base; Cancer 2008 Jul;113(1):78-83.

^[10] H L Kim, et al; Paraneoplastic signs and symptoms of renal cell carcinoma: implications for prognosis; J Urol 2003 Nov;170(5):1742-6

^[11] R M Bukowski; Natural history and therapy of metastatic renal cell carcinoma: the role of interleukin-2; Cancer 1997; 80:1198-1220

^[12] Mohammed Al Otaibi, et al; Locally advanced renal cell carcinoma; Canadian Urological Association Journal; 2007; 1 (2): S55-S61

^[13] O D Garcia, et al; Surgical stratification of renal carcinoma with extension into inferior vena cava; Actas Urol Esp; 2005; 29 (5); 448-456

^[14] Robert J Motzer, et al; National Comprehensive Cancer Network clinical practice guidelines in oncology – Kidney Cancer V.2.2010; www.nccn.org

^[15] D A Goldfarb, et al; Magnetic resonance imaging for assessment of vena caval tumor thrombi: a comparative study with venocavography and computerized tomography scanning; J Urol 1990; 144: 1100-3

^[16] N Lawrentschuk, et al; Multidetector computed tomography vs magnetic resonante imaging for defining tthe upper limito f tumour thrombus in renal cell carcinoma: a study and review; BJU Int 2005; 96 (3) 291-295

^[17] P J Hallscheidt, et al; Preoperative staging of renal cell carcinoma with inferior vena cava thrombus using multidetector CT and MRI: prospective study with histopathological correlation; J Comput Assist Tomogr 2005; 29: 64-8

^[18] J Rioja Zuazu, et al; Extracorporeal circulation and hypothermy surgery in tumors with vena cava extension: 20 years experience at the University Clinic of Navarra; Actas Urol ESp; 2008; 32 (4): 396-405

^[19] M L Blute, et al; The Mayo Clinic experience with surgical management complications ant outcome for patients with renal cell carcinoma and venous tumour thrombus; BJU Int 2004; 94: 33-41

^[20] G Ciancio, et al; Surgical management of renal cell carcinoma with tumor thrombus in the renal and inferior vena cava: the University of Miami experience in using liver transplantation techniques; Eur Urol; 2007; 51 (4); 988-995

^[21] M Gallucci, et al; Liver harvesting surgical technique for the treatment of retro-hepatic caval thrombosis concomitant to renal cell carcinoma: prerioperative and long-term results in 15 patients without mortality; Eur Urol 2004; 45: 194-202

^[22] M Jibiki, et al; Surgical strategy for treating a renal neoplasm invading the inferior vena cava; J Vasc Surg 2004; 39: 829-35

^[23] American Cancer Society; Cancer Facts & Figures 2010; Atlanta; American Cancer Society; 2010

^[24] V Ficarra, W Artibani; Staging system of renal cell carcinoma: cirrent issues; Eur Urol 2006; 49: 223-5

^[25] R H Thompson, et al; Reclassification of patients with pT3 and pT4 renal cell carcinoma improves prognostic accuracy; Cancer 2005; 104: 53-60

 

Correspondência: Sérgio Pereira sahpereira@sapo.pt 965616911

Apresentado no X Congresso Anual da Sociedade Portuguesa de Angiologia e Cirurgia Vascular – 02 a 05 de Junho de 2010