Introduction: A subset of patients with renal cell carcinoma (RCC) have tumor involvement of the inferior vena cava (IVC). Infrequently, IVC resection, is sometimes necessary. Oncological outcomes of renal cancer patients with IVC at our institution have been previously reported by Master et al. In this study, we retrospectively compared the renal function, lymphedema rate, and complications in patients with RCC who underwent IVC ligation versus those who underwent thrombectomy.
Methods: Resection patients were matched to thrombectomy patients on pre-operative Charlson Comorbidity Index (CCI), estimated glomerular filtration rate (eGFR), and race in a 1:2 ratio. End points included length of hospital stay, overall complications (Clavien-Dindo grade I to V), major complications (Clavien-Dindo grade IIIa and above) and change in eGFR post-operatively.
Results: 26 RCC patients who underwent IVC ligation between 2001 and 2019 were matched with 52 patients who underwent IVC thrombectomy in the same time period, of a total cohort of 276 patients. When compared to thrombectomy, resection patients had a longer average length of hospital stay (12.4 ± 9.8 days vs 8.8 ± 6.1 days, p = 0.051) and higher readmission rate (52.2% vs 33.3%, p=0.124). The resection cohort also had a higher overall complication rate at discharge (69.2% vs 34.6%, p=0.004). However, at 12 months, the rate of persistent overall and major complications for both ligation and thrombectomy cohorts were comparable; 3.8% vs 9.6% (p=0.367) and 0.0% vs 3.8% (p=0.311), respectively. Although ligation patients experienced higher rates of lymphedema (19.2% vs 5.8%), this did not reach statistical significance (p=0.065).Importantly, at 18-month follow up, mean eGFR declines were similar between ligation patients (18.8 mL/min/1.73m2) and thrombectomy patients (19.6 mL/min/1.73m2) (p=0.655). Differences in cancer-specific mortality (p=0.9523) and all-cause mortality (p=0.7506) were also not statistically significant.
Conclusions: The functional outcomes of IVC resection for cancer, compared to thrombectomy, particularly renal function are similar. IVC resection patients initially face a more challenging postoperative course, and in the long term, have similar functional outcomes, overall survival and cancer specific survival. Source of