Presentation Authors: Runzhuo Ma*, Binshuai Wang, Yuqing Liu, Zhuo Liu, Liyuan Tao, Min Lu, Guoliang Wang, Shudong Zhang, Jian Lu, Lulin Ma, Beijing, China, People's Republic of
Introduction: To define preoperative clinical and radiographic risk factors for the need for inferior vena cava (IVC) resection in the patients with renal cell carcinoma (RCC) and IVC tumor thrombus.
Methods: We reviewed data from 121 patients with renal cell carcinoma and venous tumor thrombus receiving radical nephrectomy and thrombectomy in our institution between 2015 and 2017. A total of 86 patients with Mayo 1 - 4 level tumor thrombus was included in the final analysis. The clinical features, operation details and pathology data were collected. Preoperative images were reviewed by two radiologists separately blind to patients&[prime] surgery information. Univariable and multivariable logistic regression analysis were used to evaluate clinical and radiographic risk factors of IVC resection.
Results: Of the 86 patients, 44 (51.2%) received IVC resection during thrombectomy. In univariate analysis, we found body mass index (BMI) (odds ratio [OR] = 1.22, P = 0.003), primary tumour diameter (OR = 0.84, P = 0.022), tumour thrombus width (OR = 1.08, P = 0.037), tumour thrombus level (OR = 1.57, P = 0.030) and IVC occlusion (OR = 2.67, P = 0.038) were associated with the need of resection of the IVC. After adjusted for other factors, BMI (OR = 1.18, P = 0.019) was the only significant risk factor of IVC resection. Multivariable analysis in Mayo 2 - 4 subgroup confirmed BMI as a independent risk factor (OR = 1.26, P = 0.024). A correlation between BMI and width (Pearson's correlation coefficient [PCC] = 0.27, P = 0.014) and length (PCC = 0.23, P = 0.037) of the tumour thrombus was noticed.
Conclusions: We identified BMI as an independent risk factor for the need for IVC resection during thrombectomy of RCC with tumor thrombus. It warrants more careful preoperative preparation for the vascular resection and/or reconstruction in patients with higher BMI.