Presentation Authors: Matthew Winter*, Alessandro Tafuri, Rivas Marielena, Giovanni Cacciamani, Shane Pearce, Aliasger Shakir, Luis Medina, Akbar Ashrafi, Los Angeles, CA, Walter Artibani, Verona, Italy, Andre Abreu, Monish Aron, Mihir Desai, Djaladat Hooman, Anne Schuckman, Sia Daneshmand, Vinay Duddalwar, Inderbir Gill, Los Angeles, CA
Introduction: To evaluate the use of three-dimensional (3D) reconstruction to measure tumor, renal vein and IVC volumetric parameters, which could then be used to predict surgical outcomes during IVC (inferior vena cava) thrombectomy.
Methods: We identified 83 consecutive patients who underwent open or robotic level II-III IVC tumor thrombectomy, between November 2007 and December 2017 in 2 high volume centers. Using 3D reconstructions, via the Synapse system, an experienced uro-radiologist evaluated (CT and/or MRI) and quantitated the preoperative imaging in each patient to provide comprehensive volumetric measurements (Figure 1). We compared these measurements with surgical outcomes (operative time, estimated blood loss (EBL), units of transfusion required and length of stay (LOS) and complications graded by Clavien-Dindo. Univariate analysis and multivariable regression analysis were performed to determine independent associations between outcomes and dependent variables.
Results: Measured volumetric components are outlined in Table 1. On univariate analysis operative time was associated with maximum thrombus diameter (MTD) (Rho 0.31) and IVC thrombus volume (ITV) (Rho 0.32) (p < 0.05). EBL was correlated with renal tumor volume (Rho 0.24), MTD (Rho 0.33), ITV (Rho 0.46) and total tumor volume (TTV) (Rho 0.29) (p < 0.05). Need for transfusion was associated with percent of IVC occlusion (Rho 0.36), MTD (Rho 0.35), ITV (Rho 0.45), MCD (Rho 0.33), TTV (Rho 0.23) and superior IVC diameter (Rho 0.29) (p < 0.05). Length of stay was correlated with ITV (Rho 0.25) (p < 0.05). On multivariable linear regression ITV remained an independent predictor of operative time (p=0.002), EBL (p < 0.001), need of transfusion ( < 0.001) and LOS (p=0.009). On multivariable logistic regression, ITV remained an independent predictor for complications (OR=1.02, p=0.009). Median ITV of level III cohort (n=54) was 34mls and was found to be the most accurate predictor of level III surgical outcomes; operative time (p=0.003), EBL (p < 0.001), need of transfusion (p=0.008) and LOS (p=0.02).
Conclusions: Our study demonstrates the utility of tumor volumetrics using 3D reconstruction to predict surgical outcomes in level II and III caval thrombectomy. IVC thrombus volume is a valuable prognostic indicator to predict surgical outcomes.