Outcomes in Patients with Renal Cell Carcinoma Undergoing Inferior Vena Cava Ligation without Reconstruction versus Thrombectomy: A Retrospective, Case Controlled Study

No AccessJournal of UrologyAdult Urology1 Feb 2021Outcomes in Patients with Renal Cell Carcinoma Undergoing Inferior Vena Cava Ligation without Reconstruction versus Thrombectomy: A Retrospective, Case Controlled StudyThis article is commented on by the following:Editorial CommentEditorial Comment Lillian Xie, Gordon Hong, Reza Nabavizadeh, Dattatraya Patil, Cecilia G. Ethun, Kenneth Ogan, Shishir K. Maithel, and Viraj A. Master Lillian XieLillian Xie *Correspondence: Emory University School of Medicine, 1365 Clifton Rd. NE, Atlanta, Georgia 30322 (email: E-mail Address: [email protected]; E-mail Address: [email protected] Department of Urology, Emory University, Atlanta, Georgia More articles by this author , Gordon HongGordon Hong Northeast Ohio Medical University, Rootstown, Ohio More articles by this author , Reza NabavizadehReza Nabavizadeh Department of Urology, Emory University, Atlanta, Georgia More articles by this author , Dattatraya PatilDattatraya Patil Department of Urology, Emory University, Atlanta, Georgia More articles by this author , Cecilia G. EthunCecilia G. Ethun Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, Georgia More articles by this author , Kenneth OganKenneth Ogan Department of Urology, Emory University, Atlanta, Georgia More articles by this author , Shishir K. MaithelShishir K. Maithel Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, Georgia Winship Cancer Institute, Emory University, Atlanta, Georgia More articles by this author , and Viraj A. MasterViraj A. Master *Correspondence: Emory University School of Medicine, 1365 Clifton Rd. NE, Atlanta, Georgia 30322 (email: E-mail Address: [email protected]; E-mail Address: [email protected] Department of Urology, Emory University, Atlanta, Georgia Winship Cancer Institute, Emory University, Atlanta, Georgia Principal investigator. More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001354AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Radical nephrectomy with tumor thrombectomy is considered standard of care in patients with renal cell carcinoma. However, surgical ligation and interruption of the inferior vena cava is sometimes necessary when the tumor thrombus invades the inferior vena cava wall. This study assesses the outcomes in patients with renal cell carcinoma undergoing inferior vena cava ligation compared to inferior vena cava thrombectomy. Materials and Methods: We conducted a case controlled, retrospective study at a high volume single-center institution. All patients with renal cell carcinoma who underwent ligation without reconstruction were matched with patients undergoing thrombectomy in a 1:2 ratio based on preoperative renal function, renal cell carcinoma stage and intraoperative thrombus level. Endpoints were complications, change in renal function and mortality. Results: A total of 26 patients with renal cell carcinoma who underwent inferior vena cava ligation between 2005 and 2019 were matched with 52 patients who underwent inferior vena cava thrombectomy in the same time period. When compared to thrombectomy, patients undergoing ligation 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 followup the rate of persistent overall and major complications for both ligation and thrombectomy groups were comparable at 49% vs 31% (p=0.497) ad 8% vs 8% (p=1.000), respectively. Importantly, at 18-month followup, mean estimated glomerular filtration rate declines were similar between ligation group (8.5 ml/min/1.73 m2) and thrombectomy group (9.9 ml/min/1.73 m2; 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 inferior vena cava ligation compared to inferior vena cava thrombectomy for renal cell carcinoma are similar. Patients with inferior vena cava ligation initially face a more complicated postoperative course but in the longer term have similar renal function recovery, complication rates and survival. References 1. : Surgical management of renal cell carcinoma with intracaval neoplastic extension above the hepatic veins. J Urol 1988; 139: 1166. Link, Google Scholar 2. : Renal cell carcinoma: surgical management of regional lymph nodes and inferior vena-caval tumor thrombus. Semin Surg Oncol 1988; 4: 129. Google Scholar 3. : Renal cell carcinoma extending into the inferior vena cava: the prognostic significance of the level of vena caval involvement. J Urol 1984; 132: 1097. Link, Google Scholar 4. : Surgical resection and inferior vena cava reconstruction for treatment of the malignant tumor: technical success and outcomes. Ann Vasc Dis 2014; 7: 120. Google Scholar 5. : Natural history of untreated renal cell carcinoma with venous tumor thrombus. Urol Oncol 2013; 31: 1305. Google Scholar 6. : Prognostic value of renal vein and inferior vena cava involvement in renal cell carcinoma. Eur Urol 2009; 55: 452. Google Scholar 7. : Results of inferior vena caval interruption by greenfield filter, ligation or resection during radical nephrectomy and tumor thrombectomy. J Urol 2007; 178: 440. Link, Google Scholar 8. : Oncologic outcomes following surgical resection of renal cell carcinoma with inferior vena caval thrombus extending above the hepatic veins: a contemporary multicenter cohort. J Urol 2014; 192: 1050. Link, Google Scholar 9. : The value of a cross-discipline team-based approach for resection of renal cell carcinoma with IVC tumor thrombus: a report of a large, contemporary, single-institution experience. J Surg Oncol 2018; 118: 1219. Google Scholar 10. : Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205. Google Scholar 11. : Resection of the inferior vena cava for neoplasms with or without prosthetic replacement: a 14-patient series. Ann Surg 2001; 233: 242. Google Scholar 12. : Surgical technique, morbidity, and outcome of primary retroperitoneal sarcoma involving inferior vena cava. Ann Surg Oncol 2012; 19: 511. Google Scholar 13. : Inferior vena cava resection without reconstruction for retroperitoneal malignancies. J Surg Case Rep 2019; 2019: rjz275. Google Scholar 14. : Replacement of the inferior vena cava for malignancy: an update. J Vasc Surg 2000; 31: 270. Google Scholar 15. : Should the inferior vena cava be reconstructed after resection for malignant tumors?Am J Surg 2005; 189: 419. Google Scholar © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology30 Nov 2020Editorial CommentJournal of Urology30 Nov 2020Editorial Comment Volume 205Issue 2February 2021Page: 383-391 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsligationinferiorthrombectomycarcinoma, renal cellvena cavatreatment outcomeMetricsAuthor Information Lillian Xie Department of Urology, Emory University, Atlanta, Georgia *Correspondence: Emory University School of Medicine, 1365 Clifton Rd. NE, Atlanta, Georgia 30322 (email: E-mail Address: [email protected]; E-mail Address: [email protected] More articles by this author Gordon Hong Northeast Ohio Medical University, Rootstown, Ohio More articles by this author Reza Nabavizadeh Department of Urology, Emory University, Atlanta, Georgia More articles by this author Dattatraya Patil Department of Urology, Emory University, Atlanta, Georgia More articles by this author Cecilia G. Ethun Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, Georgia More articles by this author Kenneth Ogan Department of Urology, Emory University, Atlanta, Georgia More articles by this author Shishir K. Maithel Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, Georgia Winship Cancer Institute, Emory University, Atlanta, Georgia More articles by this author Viraj A. Master Department of Urology, Emory University, Atlanta, Georgia Winship Cancer Institute, Emory University, Atlanta, Georgia *Correspondence: Emory University School of Medicine, 1365 Clifton Rd. NE, Atlanta, Georgia 30322 (email: E-mail Address: [email protected]; E-mail Address: [email protected] Principal investigator. More articles by this author Expand All Advertisement PDF downloadLoading ...