In patients with renal cell carcinoma (RCC) the role of the extent of tumor thrombus into the inferior vena cava (IVC) has never been addressed from a surgical and oncologic standpoint. This study aims to evaluate differences between level III-IV versus level I-II patients concerning peri- and postoperative morbidity, additional treatments and long-term oncological outcomes.
Overall, 40 patients with RCC underwent radical nephrectomy (RN) with IVC thrombectomy at a single European institution between 2010 and 2023. Complications were reported according to the European Union (EAU) guidelines recommendations. Spider chart served as graphical depiction of surgical and oncologic outcomes.
Overall, 22 (55%) and 18 (45%) patients harbored level III-IV and I-II IVC thrombus. Level III-IV patients experienced significantly higher rates of intraoperative transfusions (68 vs 39%), but not significantly higher rates of intraoperative complications (32% vs 28%). Level III-IV patients had significantly higher rates of postoperative transfusions (82% vs 33%) and Clavien Dindo ≥3 complications (41% vs 15%). In level III-IV versus level I-II patients, median follow up was 482 and 1070 days, the rate of distant recurrence was 59% and 50%, the rate of systemic progression was 27% and 13%, and the rate of additional treatment/s was 64% and 61%, respectively (all p values > 0.05). Overall survival was 36% in level III-IV patients and 67% in level I-II (p = 0.001).
Our findings suggest that patients with level III-IV RCC who are candidates for IVC thrombectomy should be counselled about the higher likelihood of postoperative severe adverse events and worse overall survival relative to level I-II counterparts.
Annals of surgical oncology. 2024 Jul 26 [Epub ahead of print]
Paolo Dell'Oglio, Stefano Tappero, Giuditta Mandelli, Tommaso Saccucci, Edoardo Dibilio, Alberto Caviglia, Enrico Vecchio, Ofir Maltzman, Marco Martiriggiano, Alberto Olivero, Silvia Secco, Michele Barbieri, Dario Di Trapani, Carlo Buratto, Erika Palagonia, Elena Strada, Giancarlo Napoli, Giovanni Petralia, Aldo Massimo Bocciardi, Antonio Galfano
Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. ., Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy.