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<a href="http://doi.org/10.1097/ju.0000000000001354" target="_blank" rel="noreferrer noopener">http://doi.org/10.1097/ju.0000000000001354</a>
Pages
101097JU0000000000001354
ISSN
1527-3792
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Update Year & Number
September 2020 List
NEOMED College
NEOMED College of Medicine Student
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NEOMED Student Publications
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Title
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Outcomes in patients with renal cell carcinoma undergoing inferior vena cava ligation without reconstruction versus thrombectomy: A retrospective, case-controlled study.
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The Journal Of Urology
Date
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2020
2020-09-09
Subject
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inferior vena cava (IVC); functional outcomes; ligation; renal cell carcinoma (RCC); thrombectomy
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Xie L;Hong G;Nabavizadeh R;Patil D;Ethun CG;Ogan K;Maithel SK;Master VA
Description
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Purpose: Radical nephrectomy with tumor thrombectomy is considered standard of care in patients with renal cell carcinoma (RCC). Surgical ligation and interruption of the inferior vena cava (IVC), however, is sometimes necessary when the tumor thrombus invades the IVC wall. This study assesses the outcomes in patients with RCC undergoing IVC ligation compared to IVC thrombectomy.; Methods: We conducted a case-controlled, retrospective study at a high-volume single-center institution. All RCC patients who underwent ligation without reconstruction were matched with thrombectomy patients in a 1:2 ratio based on pre-operative renal function, RCC stage, and intraoperative thrombus level. Endpoints were complications, change in renal function, and mortality.; Results: 26 RCC patients who underwent IVC ligation between 2005 and 2019 were matched with 52 patients who underwent IVC thrombectomy in the same time period. When compared to thrombectomy, ligation patients had higher 90-day readmission rate (19% vs 4%, p = 0.025). The ligation group also had a higher postoperative complication rate (73% vs 39%, p = 0.004) and higher rates of lymphedema (23% vs 8%, p = 0.055) . However, by 1-month follow-up, the rate of persistent overall and major complications for both ligation and thrombectomy groups were comparable; 49% vs 31% ( p = 0.497) 8% vs 8% ( p = 1.000), respectively. Importantly, at 18-month follow up, mean eGFR declines were similar between ligation patients (8.5 mL/min/1.73m 2 ) and thrombectomy patients (9.9 mL/min/1.73m 2 ) ( p = 0.834). Differences in cancer-specific mortality ( p = 0.993 ) and all-cause mortality ( p = 0.756) were also not statistically significant.; Conclusions: The outcomes of IVC ligation compared to IVC thrombectomy for RCC are similar. IVC ligation patients initially face a more complicated postoperative course, but in the longer term, have similar renal function recovery, complication rates, and survival.
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<a href="http://doi.org/10.1097/ju.0000000000001354" target="_blank" rel="noreferrer noopener">10.1097/ju.0000000000001354</a>
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journalArticle
2020
Ethun CG
functional outcomes
Hong G
inferior vena cava (IVC)
journalArticle
Ligation
Maithel SK
Master VA
Nabavizadeh R
NEOMED College of Medicine Student
NEOMED Student Publications
Ogan K
Patil D
renal cell carcinoma (RCC)
September 2020 List
The Journal of urology
thrombectomy
Xie L