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.
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.
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/1.73m2) and thrombectomy patients (9.9 mL/min/1.73m2) (p = 0.834). Differences in cancer-specific mortality (p = 0.993) and all-cause mortality (p = 0.756) were also not statistically significant.
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.
The Journal of urology. 2020 Sep 09 [Epub ahead of print]
Lillian Xie, Gordon Hong, Reza Nabavizadeh, Dattatraya Patil, Cecilia G Ethun, Kenneth Ogan, Shishir K Maithel, Viraj A Master
Department of Urology, Emory University, Atlanta, GA., Northeast Ohio Medical University, Rootstown, OH., Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA.