Clinical outcomes in patients with renal cell carcinoma with venous tumour thrombus: 10-year single centre experience.

Introduction and Objectives: To evaluate long-term outcomes in patients undergoing radical nephrectomy and tumour thrombectomy at Monash Health over the last 10 years. Method(s): We performed a retrospective analysis of 27 patients undergoing surgery between 2005 and 2015. Follow-up data were available for 24 patients. Data on clinical presentation, laboratory and imaging investigations, tumour characteristics, staging, operative details, complications, and long-term follow-up were evaluated. Result(s): Twenty-seven patients were included in the study (19 males, 8 females). Patients aged between 37- 80 years with a mean age of 61 years. Eighteen patients (67%) had nodal or distant metastasis at the time of diagnosis. According to AJCC tumour thrombus classifications - level I in 13 patients (48%), level II in 5 patients (19%) and level III in 2 patients (7%). Post-operative complications of Clavien-Dindo grade III or above occurred in 4 patients (15%). Four patients (15%) received adjuvant chemotherapy and 10 patients (37%) received tyrosine-kinase inhibitor (TKI) therapy post-operatively. Mean follow-up period in this cohort was 62 months. At the time of follow-up 21 patients (78%) were still alive. Of the 6 deaths, 4 patients died of metastatic RCC, 1 patient died during re-operation and the cause of death was not recorded for the last patient. Conclusion(s): Radical nephrectomy and tumour thrombectomy offer reasonable long-term survival in patients with locally advanced RCC. The complication rates at our centre are comparable with that of the literature.