Presentation Authors: Binshuai Wang*, Lulin Ma, Beijing, China, People's Republic of
Introduction: To evaluate the pre-operative radiographic predictors for the need of inferior vena cava resection during radical nephrectomy and inferior vena cava tumor thrombectomy.
Methods: Clinical and radiographic data were collected on 110 patients with RCC and IVC tumor thrombus (levels Iâ€“IV) at the Peking University Third Hospital between May 2015 and March 2018.Univariable and multivariable logistic regression, receiver operating characteristic (ROC) were used to assess the relationship between preoperative imaging features and intraoperative vena cava resection.
Results: Of the 110 patients, 41 underwent partial or segmental resection of IVC. Univariable associations of preoperative radiographic features with need for IVC resection are Mayo classification, maximum anterior-posterior (AP) diameter of the renal vein at the renal vein ostium (RVo), maximum AP diameter of the venous tumor thrombus (VTT) at the RVo and the IVC occlusion; On multivariable analysis, the AP diameter of the VTT at the RVo and IVC occlusion were associated with a significantly increased risk of IVC resection. Optimum radiographic thresholds to predict the need for IVC resection include AP diameter of the VTT at the RVo greater than 17.0mm and IVC occlusion. The probability of intraoperative IVC resection for a patient with the absence of both independent factors, AP diameter of the VTT at the RVo greater than 17.0mm, IVC occlusion or the two concurrent factors is 4.5%, 22.7%, 55.5% and 65.7%, respectively.
Conclusions: Increases in AP VTT diameter at the RVo and complete occlusion of the IVC are independent risk factors that are associated with a higher probability of intra-operative vena cava resection.