Outcomes in Renal Cell Carcinoma Patients Undergoing IVC Ligation vs Thrombectomy: A Retrospective, Case-Controlled Study

Outcomes in Renal Cell Carcinoma Patients Undergoing IVC Ligation vs Thrombectomy: A Retrospective, Case-Controlled Study

Xie, L., Hong, G., Patil, D., Nabavizadeh, R., Ethun, C. G., Maithel, S. K., Cardona, K., Ogan, K., & Master, V. A.

Journal of the American College of Surgeons

2019

Introduction Radical nephrectomy with removal of tumor thrombus is considered the standard of care in patients with non-metastatic renal cell carcinoma (RCC). Surgical resection usually consists of nephrectomy and thrombectomy; however, ligation of the IVC is sometimes necessary. This study assesses the outcomes, particularly functional outcomes, in RCC patients undergoing IVC ligation compared with caval thrombectomy. Methods We conducted a case-controlled, retrospective study at a high-volume single-center institution. All RCC patients undergoing ligation were matched with thrombectomy patients in a 1:2 ratio based on preoperative renal function, Charlson Comorbidity Index (CCI), and race. End points were complications, change in renal function, and mortality. Results A total of 20 IVC ligation patients were matched with 40 thrombectomy patients. Median follow-up time was 15.3 months for both groups. There was no statistical difference in major complications (Clavien-Dindo Grade 3a+) between cohorts in their postoperative hospital stay (p = 0.345) or at 3 months (p = 0.464). Average decline in estimated glomerular filtration rate from baseline to 6 months post operation for ligation and thrombectomy was 4.6 mL/min/1.73 m2 and 6.0 mL/min/1.73 m2, respectively (p = 0.767). The difference in likelihood of lymphedema development (odds ratio 0.15; 95% CI 0.02 to 1.03; p = 0.054) was not statistically significant, though more ligation patients experienced lymphedema development. In addition, differences in all-cause mortality (p = 0.197) and cancer-specific mortality (p = 1.00) were also not statistically significant at all time points. Conclusions This study represents, to our knowledge, the largest cohort of RCC patients undergoing IVC ligation to date. Although IVC ligation patients experience more complications, they have similar functional and oncologic outcomes.

10.1016/j.jamcollsurg.2019.08.696

Lillian Xie BA, Gordon Hong BS, Dattatraya Patil MBBS, MPH, Reza Nabavizadeh MD, Cecilia G.Ethun MD, MSc, Shishir K. Maithel MD, FACS, Kenneth Cardona MD, FACS, Kenneth Ogan MD, Viraj A.Master MD, PhD, FACS

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Journal Article

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

S318-S319

4, Supplement 1

229

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