Surgical and Oncological Outcomes of Level III-IV Versus Level I-II Inferior Vena Cava Thrombectomy: A Decennial Experience of a High-Volume European Referral Center.

Autor: Dell'Oglio P; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.; Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands., Tappero S; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. stefano.m.tappero@gmail.com., Mandelli G; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Saccucci T; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.; Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy.; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy., Dibilio E; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.; Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy., Caviglia A; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Vecchio E; Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy.; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy., Maltzman O; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Martiriggiano M; Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy.; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy., Olivero A; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Secco S; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Barbieri M; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Di Trapani D; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Buratto C; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Palagonia E; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Strada E; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Napoli G; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Petralia G; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Bocciardi AM; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Galfano A; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Nov; Vol. 31 (12), pp. 8383-8393. Date of Electronic Publication: 2024 Jul 26.
DOI: 10.1245/s10434-024-15878-6
Abstrakt: Background: In patients with renal cell carcinoma (RCC) the role of the extent of tumor thrombus into the inferior vena cava (IVC) has never been addressed from a surgical and oncologic standpoint. This study aims to evaluate differences between level III-IV versus level I-II patients concerning peri- and postoperative morbidity, additional treatments and long-term oncological outcomes.
Patients and Methods: Overall, 40 patients with RCC underwent radical nephrectomy (RN) with IVC thrombectomy at a single European institution between 2010 and 2023. Complications were reported according to the European Union (EAU) guidelines recommendations. Spider chart served as graphical depiction of surgical and oncologic outcomes.
Results: Overall, 22 (55%) and 18 (45%) patients harbored level III-IV and I-II IVC thrombus. Level III-IV patients experienced significantly higher rates of intraoperative transfusions (68 vs 39%), but not significantly higher rates of intraoperative complications (32% vs 28%). Level III-IV patients had significantly higher rates of postoperative transfusions (82% vs 33%) and Clavien Dindo ≥3 complications (41% vs 15%). In level III-IV versus level I-II patients, median follow up was 482 and 1070 days, the rate of distant recurrence was 59% and 50%, the rate of systemic progression was 27% and 13%, and the rate of additional treatment/s was 64% and 61%, respectively (all p values > 0.05). Overall survival was 36% in level III-IV patients and 67% in level I-II (p = 0.001).
Conclusions: Our findings suggest that patients with level III-IV RCC who are candidates for IVC thrombectomy should be counselled about the higher likelihood of postoperative severe adverse events and worse overall survival relative to level I-II counterparts.
(© 2024. Society of Surgical Oncology.)
Databáze: MEDLINE
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