Department of Urology, Peking University Third Hospital, Beijing, China.
BMC Surg. 2021 Nov 21;21(1):402. doi: 10.1186/s12893-021-01400-2.
To analyze the influence of inferior vena cava (IVC) interruption for perioperative and oncological results in patients with renal cell carcinoma and tumor thrombus and summarize the surgical strategies of IVC interruption for different situations.
We retrospectively analyzed the clinical and pathological data of 103 patients in our center. Patients were divided into two groups with 32 cases (31.1%) underwent IVC interruption (Group 1) while 71 cases (68.9%) did not. For comparison of continuous variables, the Mann-Whitney U test was used. For comparison of categorical variables, Chi-square tests were used. A propensity score based matching method was used to eliminate possible bias. Kaplan-Meier plots were performed to evaluate the influence of IVC interruption on overall survival and cancer specific survival. All the statistical analyses were performed using SPSS 24. A P value < 0.05 was considered statistically significant.
Among the 32 patients who underwent IVC interruption, the median age was 61 years and the median tumor size was 7.7 cm. There were 28 males and 23 tumors were on the right side. We successfully matched 29 patients who underwent IVC interruption to 29 patients without this procedure in 1:1 ratio. No significant differences existed in baseline characteristics between the groups. The comparison of perioperative data showed that patients who underwent IVC interruption had significantly longer median postoperative hospital stays (13 vs 9 days, P = 0.022) and a higher overall postoperative complication rate (79.3 vs 51.7%, P = 0.027). According to the side and shape of tumor thrombus, it could be divided into four categories. There were 15 cases (46.9%) with right filled-type tumor thrombus (RFTT), 8 cases (25.0%) with right non-filled-type tumor thrombus (RNFTT), 1 case (3.1%) with left filled-type tumor thrombus (LFTT) and 8 cases (25.0%) with left non-filled-type tumor thrombus (LNFTT). According to different categories, different surgical procedures were adopted.
IVC interruption will increase the incidence of overall postoperative complications, but not the risk of major postoperative complications. Tumor thrombus should be divided into four categories, and different sides and shapes of renal tumor thrombus need different operative procedure of IVC interruption.
分析下腔静脉（IVC）阻断对伴有肿瘤栓子的肾细胞癌患者围手术期和肿瘤学结果的影响，并总结不同情况下 IVC 阻断的手术策略。
我们回顾性分析了我中心 103 例患者的临床和病理资料。患者分为两组，32 例（31.1%）行 IVC 阻断（组 1），71 例（68.9%）不行 IVC 阻断（组 2）。连续变量比较采用 Mann-Whitney U 检验，分类变量比较采用卡方检验。采用倾向评分匹配法消除可能的偏倚。采用 Kaplan-Meier 法评估 IVC 阻断对总生存和肿瘤特异性生存的影响。所有统计分析均采用 SPSS 24 软件进行。P 值<0.05 认为具有统计学意义。
在 32 例行 IVC 阻断的患者中，中位年龄为 61 岁，中位肿瘤大小为 7.7cm。男性 28 例，右侧肿瘤 23 例。我们成功地将 29 例接受 IVC 阻断的患者与 29 例未接受该手术的患者进行了 1:1 匹配。两组患者的基线特征无显著差异。围手术期数据比较显示，行 IVC 阻断的患者术后中位住院时间明显延长（13 天比 9 天，P=0.022），总术后并发症发生率较高（79.3%比 51.7%，P=0.027）。根据肿瘤栓子的位置和形状，可将其分为四类：右满型肿瘤栓子（RFTT）15 例（46.9%），右非满型肿瘤栓子（RNFTT）8 例（25.0%），左满型肿瘤栓子（LFTT）1 例（3.1%），左非满型肿瘤栓子（LNFTT）8 例（25.0%）。根据不同类型，采用不同的手术方式。
IVC 阻断会增加总术后并发症的发生率，但不会增加主要术后并发症的风险。肿瘤栓子可分为四类，不同部位和形状的肾肿瘤栓子需要不同的 IVC 阻断手术方式。
