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Management of Renal Cell Carcinoma with IVC Thrombus, Nodal Involvement, and T4 Disease

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Integrating Multidisciplinary Treatment for Advanced Renal Cell Carcinoma

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Abstract

Locally advanced, nonmetastatic renal cell carcinoma describes renal cell carcinoma involving tissues outside of the renal parenchyma including the peri- and intra-renal fat, neighboring organs, and regional (e.g., retroperitoneal) lymph nodes as well those tumors with vascular invasion into the renal vein and its branches, and the inferior vena cava, staged as cT3-4 N1 M0 disease. The cornerstone of the management of locally advanced renal cell carcinoma remains surgical extirpation. Due to the extent of locally advanced renal cell carcinoma, these operations may require technically complex maneuvers include en bloc excision of neighboring organs to obtain a complete resection with negative margins (R0). Complex multidisciplinary coordination is frequently required to optimize preparedness and patient outcomes. In this chapter, we review the preoperative evaluation and risk stratification for patients with locally advanced renal cell carcinoma including those with involvement of the IVC. We discuss technical considerations for the surgical management of this disease including IVC thrombectomy, lymphadenectomy, and considerations for resecting adjacent involved structures (cT4 disease), as well as review the existent data regarding the evolving role for neoadjuvant and adjuvant systemic therapy in this disease space.

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Acknowledgments

The authors would like to thank Dr. Ponsky and Dr. Uzzo for providing radiographic and intraoperative imaging.

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Authors and Affiliations

  1. Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Laura Bukavina

  2. Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA

    Avery Braun

  3. The Johns Hopkins Hospital, Brady Urological Institute, Baltimore, MD, USA

    Michelle Higgens

  4. Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Megan Prunty

  5. Department of Urology, University of Washington, Seattle, WA, USA

    Sarah P. Psutka

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Correspondence to Sarah P. Psutka .

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  1. Moores Cancer Center, University of California San Diego, La Jolla, CA, USA

    Rana R. McKay

  2. Division of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Eric A. Singer

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Bukavina, L., Braun, A., Higgens, M., Prunty, M., Psutka, S.P. (2023). Management of Renal Cell Carcinoma with IVC Thrombus, Nodal Involvement, and T4 Disease. In: McKay, R.R., Singer, E.A. (eds) Integrating Multidisciplinary Treatment for Advanced Renal Cell Carcinoma. Springer, Cham. https://doi.org/10.1007/978-3-031-40901-1_7

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  • Online ISBN: 978-3-031-40901-1

  • eBook Packages: MedicineMedicine (R0)

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