Presentation Authors: Yasuyoshi Okamura*, Mariko Sakamoto, Yukari Bando, Kotaro Suzuki, Takuto Hara, Tomoaki Terakawa, Jyunya Furukawa, Kenichi Harada, Nobuykuki Hinata, Yuzo Nakano, Masato Fujisawa, Kobe, Japan
Introduction: Previous studies reported that presurgical treatment with molecular targeted drug reduced operation risk by downsizing of tumor thrombus in patients with advanced renal cell carcinoma (RCC) with inferior vena cava tumor thrombus. We evaluated improvement of surgical outcome of resection both tumor and thrombus.
Methods: A retrospective chart review of 42 patients who was operated for advanced RCC with inferior vena cava tumor thrombus at Kobe University Hospital from March 2008 to September 2018 was performed. We investigated surgical outcome of patients who received presurgical treatment by compared with surgery alone. We used pazopanib for presurgical treatment and MAYO classification for decision of tumor thrombus level.
Results: Six patients received presurgical treatment before surgery and remaining 36 patients were treated with surgery alone. In presugical group there were 3 patients with level 3 thrombus and 3 patients with level 4 thrombus. In surgery alone group there were 12 patients with level 1 thrombus, 14 with level 2, 5 with level 3, 5 with level 4. In presurgical treatment group 4 patients showed reduction of tumor thrombus, of which 2 patients could avoid thoracic cavity approach and extracorporeal circulation. The average operation time were 500 min in presurgical group and 454 min in surgery alone group (P=0.51). the average blood loss were 1600 ml in presurgical group and 3192ml in surgery alone group (P=0.38). the average postoperative hospitalization were 13.2 days in presurgical group and 18.8 days in surgery alone group (P=0.02).In patients with level 3 and 4 thrombus in surgery alone group, the average operation time and blood loss were 627 min(presurgical 500 min, P=0.12 ) and 7393ml (presurgical 1600ml, P=0.04).Perioperative complications were observed in 33% of patients in both groups
Conclusions: Presurgical treatment with pazopanib was able to ease surgery for advanced renal cell carcinoma with inferior vena cava tumor thrombus and improved surgical outcome with respect to blood loss and postoperative hospitalization.