Radical nephrectomy (removal of the entire kidney) with caval thrombectomy (removal of the occluding thrombus from the hollow vein) is the standard treatment for malignant renal tumors that have invaded the kidney vein and resulted in neoplastic thrombosis. For the treatment of this pathology in Humanitas there is a multidisciplinary team that, coordinated by the team of Urology directed by Prof. Giorgio Guazzoni, is supported by Vascular Surgery, Hepatobiliary Surgery, Cardio Surgery, Nephrology, Oncology, Anesthesiology and Sanitation. We talked about this topic with Dr. Paolo Casale, urologist of the team of Prof. Guazzoni.


Kidney cancer and neoplastic thrombosis: what is the indicated treatment?

One third of patients with renal cancer have metastases already at the time of diagnosis. Metastatic localizations are extremely variable and are sometimes found in atypical sites such as lungs and bones. As the tumor develops, it can invade the renal vein, proliferating in the form of a solid column called a neoplastic thrombus that extends into the hollow vein. In 4-10% of cases, involvement includes both the renal and lower vena cava. In this case the surgical intervention, as standard of care, is the radical nephrectomy associated with the simultaneous removal of the neoplastic thrombus, which in some cases can develop such dimensions as to reach the right cavities of the heart. Using this surgical procedure, the surgeon removes the entire sick kidney, the adrenal gland, and the surrounding lymph nodes and at the same time the thrombus that caused the occlusion is also removed. “The complexity of the intervention – commented Dr. Casale – requires to be followed in highly specialized centers where the use of advanced technologies is combined with the experience of surgeons and a multidisciplinary methodological approach. This type of close collaboration, which involves professionals from different clinical and surgical branches, allows us to follow the patient through all the critical phases of the procedure, from surgery to post-operative hospitalization”. In Humanitas radical nephrectomy with caval thrombectomy is performed by the team of Urology coordinated by Prof. Giorgio Guazzoni with the support of vascular surgery, hepatobiliary surgery, cardiac surgery, oncology, nephrology and with the essential support of anesthetists and rejuvenators.