EAU 2019: Three Dimensional Volumetrics of Inferior Vena Cava Tumor Thrombus Predicts Surgical Outcomes

Barcelona, Spain (UroToday.com) Patients with inferior vena cava (IVC) tumor thrombus from advanced renal cell carcinoma can have a variety of surgical outcomes. Given the complex nature of these procedures, there can be extensive perioperative blood loss and a high risk for possible intraoperative and postoperative complications. The level of tumor thrombus is often correlated with the expected difficulty of surgical resection, however other patient and tumor-specific factors may play a role in surgical complexity and post-operative outcomes. A group from University of Southern California (USC) in Los Angeles, California, presented their findings regarding the use of three-dimensional (3D) radiographic reconstruction to predict surgical outcomes in patients undergoing radical nephrectomy with IVC thrombectomy.

They identified 83 consecutive patients who underwent either open or robotic radical nephrectomy with IVC thrombectomy at their institution between November 2007 and December 2017. They retrospectively created 3D reconstructions of the patient’s anatomy, including the thrombus, and an experienced uroradiologist evaluated and quantified the preoperative imaging. They recorded measurements of the renal tumor, renal vein, and IVC tumor using the 3D reconstructions and then compared these variables with surgical outcomes, including operative time, estimated blood loss (EBL), units of blood transfused perioperatively, length of stay, and perioperative complications.

The USC group found that on univariate analysis operative time was strongly associated with maximal thrombus diameter and IVC thrombus volume. EBL was associated with renal mass volume, IVC thrombus volume, and total tumor volume. The need for perioperative transfusion correlated with percent of IVC occlusion, maximal thrombus diameter, IVC thrombus volume, total tumor volume, and superior IVC diameter. The length of stay was most associated with IVC thrombus volume. On multivariate analysis IVC thrombus volume was an independent predictor of operative time ,EBL, need for transfusion, and length of stay.

They concluded that their study demonstrates the utility of tumor volumetrics using 3D reconstructions as a way of predicting surgical outcomes in patients undergoing radical nephrectomy with IVC thrombectomy. IVC thrombus volume appears to be a particularly valuable prognostic factor, which can easily be measured, in most cases. This study is significant in that 3D reconstruction technology is widely available at many institutions and does not require special technology or expertise in order to calculate tumor volume. This valuable preoperative information may be used to assist in operative planning, such as the surgical approach (open versus robotic-assisted).

Presented by: Giovanni Cacciamani, MD,  Assistant Professor of Research Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
Written by:Brian Kadow, MD. Society of Urologic Oncology Fellow, Fox Chase Cancer Center at the 34th European Association of Urology (EAU 2019) #EAU19, conference in Barcelona, Spain from March 15-19, 2019.