Outcomes in patients with renal cell carcinoma undergoing inferior vena cava ligation without reconstruction versus thrombectomy: A retrospective, case-controlled study.

Title

Outcomes in patients with renal cell carcinoma undergoing inferior vena cava ligation without reconstruction versus thrombectomy: A retrospective, case-controlled study.

Creator

Xie L;Hong G;Nabavizadeh R;Patil D;Ethun CG;Ogan K;Maithel SK;Master VA

Publisher

The Journal Of Urology

Date

2020
2020-09-09

Description

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.

Subject

inferior vena cava (IVC); functional outcomes; ligation; renal cell carcinoma (RCC); thrombectomy

Rights

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

Format

journalArticle

Search for Full-text

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Pages

101097JU0000000000001354

ISSN

1527-3792

NEOMED College

NEOMED College of Medicine Student

NEOMED Department

NEOMED Student Publications

Update Year & Number

September 2020 List

Citation

Xie L;Hong G;Nabavizadeh R;Patil D;Ethun CG;Ogan K;Maithel SK;Master VA, “Outcomes in patients with renal cell carcinoma undergoing inferior vena cava ligation without reconstruction versus thrombectomy: A retrospective, case-controlled study.,” NEOMED Bibliography Database, accessed November 24, 2020, https://neomed.omeka.net/items/show/11284.

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