Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
摘要：
背景：在肾细胞癌（RCC）患者中，从手术和肿瘤学的角度来看，肿瘤血栓进入下腔静脉（IVC）的程度的作用从未得到解决。本研究旨在评估III-IV级与I-II级患者在围手术期和术后发病率方面的差异。额外的治疗和长期的肿瘤结果。
方法：总的来说，在2010年至2023年之间，40例RCC患者在一家欧洲机构接受了根治性肾切除术（RN）和IVC血栓切除术。根据欧盟（EAU）指南建议报告并发症。蜘蛛图用作手术和肿瘤学结果的图形描述。
结果：总体而言，22例（55％）和18例（45％）患者存在III-IV级和I-II级IVC血栓。III-IV级患者的术中输血率明显较高（68vs39％），但术中并发症的发生率并不明显（32％vs28％）。III-IV级患者的术后输血率（82％vs33％）和ClavienDindo≥3种并发症（41％vs15％）明显更高。在III-IV级与I-II级患者中，中位随访时间为482天和1070天，远处复发率分别为59%和50%,全身进展率为27%和13%，额外治疗率分别为64%和61%，分别(所有p值>0.05)。III-IV级患者的总生存率为36％，I-II级患者为67％（p=0.001）。
结论：我们的研究结果表明，与I-II级患者相比，III-IV级RCC患者是IVC血栓切除术的候选人，应被告知术后严重不良事件的可能性更高，总体生存率更差。
方法：总的来说，在2010年至2023年之间，40例RCC患者在一家欧洲机构接受了根治性肾切除术（RN）和IVC血栓切除术。根据欧盟（EAU）指南建议报告并发症。蜘蛛图用作手术和肿瘤学结果的图形描述。
结果：总体而言，22例（55％）和18例（45％）患者存在III-IV级和I-II级IVC血栓。III-IV级患者的术中输血率明显较高（68vs39％），但术中并发症的发生率并不明显（32％vs28％）。III-IV级患者的术后输血率（82％vs33％）和ClavienDindo≥3种并发症（41％vs15％）明显更高。在III-IV级与I-II级患者中，中位随访时间为482天和1070天，远处复发率分别为59%和50%,全身进展率为27%和13%，额外治疗率分别为64%和61%，分别(所有p值>0.05)。III-IV级患者的总生存率为36％，I-II级患者为67％（p=0.001）。
结论：我们的研究结果表明，与I-II级患者相比，III-IV级RCC患者是IVC血栓切除术的候选人，应被告知术后严重不良事件的可能性更高，总体生存率更差。
