SAN DIEGO, CA USA (UroToday.com) - Patients with kidney cancer and venous thrombus are viewed with extra scrutiny in anticipation of a high-risk surgical intervention. Those who have a prior history of pulmonary embolus (PE) are of special concern due to addition of pre-operative anticoagulation and presumed poor post-surgical outcomes.
Dr. E. Jason Abel and his team presented a multi-institutional retrospective review of 782 patients undergoing a nephrectomy with a tumor thrombectomy, with a median follow-up of 22 months. They identified 35 patients (4.4%) who had a pre-operative PE. Groups with and without PE were well matched across demographic and clinicopathologic characteristics, although those with a pre-operative PE tended to have a higher level thrombus (p < 0.01). With respect to RCC recurrence in the N0M0 subset, no significant difference was observed between the two groups, 41% in the pre-operative PE vs 50% in the no PE groups (p=0.36). Peri-nephric fat invasion, Fuhrman grade and thrombus height were predictive of RCC recurrence on a multivariable analysis. Similarly, in the N0M0 subset, pre-operative PE did not demonstrate association with development of lung metastases (p=0.71) or death from RCC (p=0.58). Multivariable analysis revealed that death from RCC was associated with the presence of metastatic disease, peri-nephric fat invasion, sarcomatoid de-differentiation, Fuhrman grade 4, and tumor diameter, while pre-operative PE did not demonstrate a significant association.
The authors concluded that PE at initial diagnosis is not associated with worse post-surgical recurrence or survival in RCC patients with tumor thrombus. While a closer look at the comorbidity and post-operatve complications profiles between the two groups may be warranted, pre-operative diagnosis of a PE should not preclude these patients from a surgical intervention.
Presented by E. Jason Abel, Christopher G. Wood, Nathan Eickstaedt, Justin E. Fang, Patrick Kenney, Aditya Bagrodia, Daniel Ramirez, Bishoy A. Gayed, Tracy M. Downs, Ramy F. Youssef, Christopher Odom, Arthur Sagalowsky, and Vitaly Margulis at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Serge Ginzburg, MD
