One case of left renal cell carcinoma with inferior vena cava tumor thrombus (Mayo Ⅲ) treated with pure laparoscopic surgery in multi body positions
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摘要: 探讨肾癌伴下腔静脉癌栓的诊断和治疗进展，特别是外科手术方式的探讨。结合文献分析对1例左肾癌伴Mayo Ⅲ型下腔静脉癌栓的诊断和治疗进行回顾性分析，该患者术前经腔静脉B超、CT以及三维重建明确诊断。行多体位全腔镜肾癌根治性切除同时行下腔静脉取栓术，该患者术后随访1年未出现肿瘤转移。肾癌伴下腔静脉癌栓诊疗难度较大，特别是Mayo Ⅲ型以上下腔静脉肾癌癌栓的处理，左侧肾癌伴下腔静脉癌栓难度更大。对无淋巴结和远处转移的患者应积极手术治疗，癌栓侵入下腔静脉的高度及有无侵犯静脉壁的判断对手术方式的选择十分重要；术后综合治疗往往可以改善患者的预后；多学科团队协作甚至是多个中心的协作模式为疑难危重病例的治疗提供了一种新的模式。Abstract: To explore the progress of diagnosis and treatment of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus (Mayo Ⅲ), especially the mode of surgery. We performed a retrospective analysis on the diagnosis and treatment of one case of renal carcinoma with IVC tumor thrombus (Mayo Ⅲ) combined with the literature review. In this case, the diagnosis was clearly established by B-ultrasound and CT of the vena cava as well as three-dimensional reconstruction before surgery. Pure laparoscopic surgery of renal carcinoma and thrombectomy of the IVC in multi body positions was performed, and this patient did not show tumor metastasis during the postoperative follow-up period of one year. The diagnosis and treatment of RCC with IVC tumor thrombus is difficult, especially for the management of patients with Mayo type Ⅲ and above IVC tumor thrombus, and left RCC with IVC tumor thrombus is more difficult. Patients without lymph node or distant metastasis should be treated aggressively with surgery, and the height of the invasion of the tumor thrombus into the IVC and the judgment of the presence or absence of invasion into the venous wall are important for the choice of surgical approach. Comprehensive postoperative treatment can often improve the prognosis of patients, and the multi-disciplinary treatment (MDT) or even the cooperation of multiple centers provides a new model for the management of difficult critical cases.
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[1] Jurado A, Romeo A, Gueglio G, et al. Current trends in management of renal cell carcinoma with venous thrombus extension[J]. Curr Urol Rep, 2021, 22(4): 23. doi: 10.1007/s11934-021-01036-y
[2] Vamour N, Gasmi A, Leroy X, et al. Impact of positive vascular margins status after surgical resection of non-metastatic renal cell carcinoma with caval tumour thrombus: a propensity score multicentre study[J]. World J Urol, 2022, 40(2): 459-465. doi: 10.1007/s00345-021-03880-6
[3] Mastoraki A, Mastoraki S, Tsikala-Vafea M, et al. Prognostic benefit of surgical management of renal cell carcinoma invading the inferior vena cava[J]. Indian J Surg Oncol, 2017, 8(1): 14-18. doi: 10.1007/s13193-016-0528-y
[4] McDougall E, Clayman RV, Elashry OM. Laparoscopic radical nephrectomy for renal tumor: the Washington University experience[J]. J Urol, 1996, 155(4): 1180-1185. doi: 10.1016/S0022-5347(01)66207-4
[5] Abaza R, Eun DD, Gallucci M, et al. Robotic surgery for renal cell carcinoma with vena caval tumor thrombus[J]. Eur Urol Focus, 2016, 2(6): 601-607. doi: 10.1016/j.euf.2017.01.001
[6] Alsina AE, Wind D, Kumar A, et al. Outcomes in renal cell carcinoma with IVC thrombectomy: a multiteam analysis between an NCI-designated cancer center and a quaternary care teaching hospital[J]. Am Surg, 2020, 86(8): 1005-1009. doi: 10.1177/0003134820942172
[7] 赖鹏, 林宗明, 郭剑明, 等. 肾细胞癌伴下腔静脉癌栓术中癌栓脱落的危险因素分析[J]. 中外医学研究, 2018, 16(18): 14-16. https://www.cnki.com.cn/Article/CJFDTOTAL-YJZY201818006.htm
[8] Keranmu A, Wang MS, Li YJ, et al. Feasibility of single position laparoscopic radical nephrectomy and tumor thrombectomy for left renal cell carcinoma with high-risk Mayo grade 0 and 1 tumor thrombus[J]. BMC Urol, 2021, 21(1): 181. doi: 10.1186/s12894-021-00924-2
[9] Horynecka Z, Jabłońska B, Kurek A, et al. Analysis of surgical outcomes in 102 patients with renal cell carcinoma with venous tumor thrombus: a retrospective observational single-center study[J]. Medicine, 2022, 101(40): e30808.
[10] 赵磊, 马潞林, 黄毅, 等. Foley尿管在肾癌合并下腔静脉癌栓中的应用[J]. 现代泌尿外科杂志, 2010, 15(1): 14-16. https://www.cnki.com.cn/Article/CJFDTOTAL-MNWK201001004.htm
[11] Tabbara MM, González J, Ciancio G. Multidisciplinary surgical approach for renal cell carcinoma with inferior vena cava tumor thrombus[J]. Surg Today, 2022, 52(7): 1120-1121.
[12] 傅红, 王海丽, 宋东奎, 等. 多学科团队协作护理模式在肾癌伴下腔静脉癌栓手术患者中的应用效果[J]. 肿瘤基础与临床, 2019, 32(6): 542-544. https://www.cnki.com.cn/Article/CJFDTOTAL-HLZL201906021.htm
[13] 马明辉, 汤晓堃, 王红军. 基于心理护理的综合护理措施对肝癌患者术后心理状态及生活质量的影响[J]. 临床医学工程, 2023, 30(1): 129-130. https://www.cnki.com.cn/Article/CJFDTOTAL-YBQJ202301065.htm
[14] 黄桂晓, 李云飞, 段启林, 等. 左肾癌合并下腔静脉、右心房癌栓1例[J]. 临床泌尿外科杂志, 2020, 35(3): 247-249. https://lcmw.whuhzzs.com/article/doi/10.13201/j.issn.1001-1420.2020.03.019
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