ACS 2019: Outcomes in Renal Cell Carcinoma (RCC) Patients Undergoing Inferior Vena Cava (IVC) Ligation versus Thrombectomy: A Retrospective, Case-Controlled Study

San Francisco, California ( Gordon Hong noted radical nephrectomy with removal of tumor thrombus is considered 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 assessed the outcomes, particularly functional outcomes, in RCC patients undergoing IVC ligation compared to caval thrombectomy.  

They 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 pre-operative renal function, Charlson Comorbidity Index (CCI), and race. Endpoints were complications, changes in renal function, and mortality.

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 (eGFR) from baseline to 6-months post-surgery for ligation and thrombectomy was 4.6 mL/min/1.73m2 and 6.0 mL/min/1.73m2, respectively (p=0.767). The difference in the likelihood of lymphedema development (OR 0.15, 95% CI: 0.02-1.03, p=0.054) was not statistically significant, though more ligation patients experienced lymphedema development. Moreover, differences in all-cause mortality (p=0.197) and cancer-specific mortality (p=1.00) were also not statistically significant at all time points.

This study represents one of 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. These data are useful for patient counseling and representative of a single high volume surgeon experience which findings may not be generalizable to others

Presented by: Gordon Hong, BS, Emory University School of Medicine, Atlanta, Georgia

Written by: Stephen B. Williams, MD, Medical Director for High Value Care; Chief of Urology, Associate Professor, Director of Urologic Oncology, Director Urologic Research, The University of Texas Medical Branch at Galveston, TX at the 2019 American College of Surgeons (ACS), #ACSCC19, October 27–31 in San Francisco, California