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Войти в исследования Annals of surgical oncology · 2025
Segmental Resection of the Inferior Vena Cava is Safe and Feasible for Patients with Renal Cell Carcinoma with Tumor Thrombus: A Large-Scale Retrospective Study from a High-Volume Center.
СтатьяНазвание и аннотация: Перевод в очереди
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Yu Le, Zhang Weiliang, Duan Peichen, Zhang Fan, Deng Shaohui, Yan Ye, Liu Zhou, Song Yimeng, Wang Guoliang, Zhang Hongxian, Hong Peng, Zhang Shudong
Аннотация
PURPOSE: We aimed to evaluate perioperative and oncological outcomes in renal cell carcinoma (RCC) with tumor thrombus (TT) patients undergoing inferior vena cava (IVC) segmental resection, with comparative analysis stratified by surgical approaches.
METHODS: A retrospective analysis was conducted on 271 RCC with TT patients. Patients' clinicopathological data were collected. Continuous variable comparisons utilized the Wilcoxon rank-sum test or unpaired t-tests based on their distribution, while categorical variable analyses employed the Chi-square test. Survival outcomes were evaluated through Kaplan-Meier estimation.
RESULTS: Overall, 123 patients (45.4%) experienced IVC segmental resection. Despite exhibiting poorer preoperative renal function, the segmental resection group achieved comparable postoperative estimated glomerular filtration rate (eGFR) as the control group (56.7 vs. 55.7 mL/min/1.73m2; p = 0.10). The overall (51.2% vs. 41.9%; p = 0.12) and major (6.5% vs. 6.1%; p = 0.89) complication rates also showed no significant difference. Robot-assisted segmental resection demonstrated superior perioperative outcomes versus open surgery: shorter postoperative hospital stay (7 vs. 10 days; p < 0.01), reduced operative time (237 vs. 371 min; p < 0.01), and less blood loss (700 vs. 1500 mL; p < 0.01). Compared with laparoscopic surgery, robot-assisted segmental resection reduced postoperative hospital stay (7 vs. 11.5 days; p < 0.01) and operative time (236.5 vs. 421.5 min; p < 0.01). Overall survival showed no significant difference between the IVC segmental and non-segmental resection cohorts.
CONCLUSION: Segmental resection of the IVC represents a safe and technically feasible intervention in RCC patients with TT, demonstrating acceptable perioperative safety in appropriately selected cases. Robot-assisted techniques significantly reduced procedural complexity and optimized perioperative outcomes.
METHODS: A retrospective analysis was conducted on 271 RCC with TT patients. Patients' clinicopathological data were collected. Continuous variable comparisons utilized the Wilcoxon rank-sum test or unpaired t-tests based on their distribution, while categorical variable analyses employed the Chi-square test. Survival outcomes were evaluated through Kaplan-Meier estimation.
RESULTS: Overall, 123 patients (45.4%) experienced IVC segmental resection. Despite exhibiting poorer preoperative renal function, the segmental resection group achieved comparable postoperative estimated glomerular filtration rate (eGFR) as the control group (56.7 vs. 55.7 mL/min/1.73m2; p = 0.10). The overall (51.2% vs. 41.9%; p = 0.12) and major (6.5% vs. 6.1%; p = 0.89) complication rates also showed no significant difference. Robot-assisted segmental resection demonstrated superior perioperative outcomes versus open surgery: shorter postoperative hospital stay (7 vs. 10 days; p < 0.01), reduced operative time (237 vs. 371 min; p < 0.01), and less blood loss (700 vs. 1500 mL; p < 0.01). Compared with laparoscopic surgery, robot-assisted segmental resection reduced postoperative hospital stay (7 vs. 11.5 days; p < 0.01) and operative time (236.5 vs. 421.5 min; p < 0.01). Overall survival showed no significant difference between the IVC segmental and non-segmental resection cohorts.
CONCLUSION: Segmental resection of the IVC represents a safe and technically feasible intervention in RCC patients with TT, demonstrating acceptable perioperative safety in appropriately selected cases. Robot-assisted techniques significantly reduced procedural complexity and optimized perioperative outcomes.
Предметные рубрики MeSH
HumansCarcinoma, Renal CellVena Cava, InferiorRetrospective StudiesKidney NeoplasmsFemaleMaleMiddle AgedNephrectomySurvival RateAgedHospitals, High-VolumeFollow-Up StudiesPrognosisFeasibility StudiesPostoperative ComplicationsRobotic Surgical ProceduresVenous ThrombosisLength of StayGlomerular Filtration RateAdultThrombectomy