Radical nephrectomy (removal of the entire kidney) with vena cava thrombectomy (removal of the thrombus occluding the vena cava) is the standard treatment for a malignant renal tumor that has invaded the renal vein. The result is tumor thrombus. Humanitas hospital has set a multidisciplinary approach to treating this disease by activating different departments. Prof. Giorgio Guazzoni (Head of Urology) has teamed up with the departments of Vascular Surgery Unit, Hepatobiliary Surgery, Cardiac Surgery, Nephrology, Oncology, and Anesthesiology and General Intensive Care. We spoke with Dr. Paolo Casale, urologist a part of the medical team of Prof. Guazzoni.
What is the appropriate treatment for kidney cancer and tumor thrombus?
About a third of patients have metastatic renal cell carcinoma as early as the diagnosis stage. Metastases are extremely variable and sometimes they are found in atypical locations such as the lungs and bones. The growth of the tumor can invade the renal vein and multiply in the form of tumor thrombus, which extends inside the vena cava. In 4-10% of cases, both the renal vein and the inferior vena cava are affected. Radical nephrectomy with simultaneous removal of the tumor thrombus is typically recommended as a surgical treatment option. Through this surgical procedure, the surgeon removes the entire diseased kidney, an adrenal gland, the surrounding lymph nodes, and any thrombus which has caused obstruction. “The complexity of the intervention – says Dr. Cassale – requires that the surgery take place in highly specialized centers. It also requires the use of advanced technologies and high surgical expertise. This type of collaboration involves professionals from different clinical and surgical branches. The patient must be taken care of in all critical stages of the procedure, from the surgery to post-operative hospital stay.” In Humanitas, radical nephrectomy with vena cava thrombectomy is performed by the team of Urology coordinated by Prof. Giorgio Guazzoni with the assistance of the departments of Vascular Surgery, Hepatobiliary Surgery, Cardiac Surgery, Nephrology, Oncology, and Anesthesiology and General Intensive Care.