Garg Harshit, Whalen Philip, Marji Haneen, Cooper Robert, Dursun Furkan, Bhandari Mukund, Khanna Lokesh, Jayakumar Lalithapriya, Liss Michael A, Svatek Robert S, Rodriguez Ronald, Kaushik Dharam, Pruthi Deepak K
Department of Urology, University of Texas Health, San Antonio, TX.
University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX.
J Vasc Surg Venous Lymphat Disord. 2023 May;11(3):595-604.e2. doi: 10.1016/j.jvsv.2023.01.004. Epub 2023 Feb 2.
The reconstruction of inferior vena cava (IVC) during radical nephrectomy and venous tumor thrombectomy (RN-VTT) is mostly performed with primary repair or with a patch/graft. We sought to systematically evaluate the outcomes of IVC patency over short- to intermediate-term follow-up for patients undergoing primary repair of IVC and to assess the association with survival.
A retrospective review of patients undergoing RN-VTT between January 2013 and August 2018 was conducted. Patients were followed until death, last available follow-up, or March 2022. The patency outcomes and IVC diameters were studied using follow-up cross-sectional imaging. The χ test, Student t test, and Kaplan-Meier survival analysis were used.
Seventy-seven patients were included. The mean age was 59.2 ± 12.2 years and 45.4% had Mayo classification level III thrombus or higher. At a median follow-up of 36.5 months (13.3-60.7 months), the 3-year overall survival (OS) was 64%. Sixty patients underwent primary repair of the IVC and 48 of these patients were assessed for IVC patency. Ten patients (20.8%) developed caval occlusion, either from recurrent tumor (8.3%), new-onset bland thrombus (8.3%), or stenosis (4.2). The IVC patency seemed to be a significant predictor of OS (hazard ratio, 2.85; P = .021). Although the IVC diameters decreased significantly at the 3-month postoperative scan at the infrarenal (P = .019), renal (P < .001), and suprarenal (P < .001) levels, they did not decrease further on long-term follow-up imaging.
IVC reconstruction with primary repair results in an overall patency rate of 80.2% with only a 4.0% rate of stenosis. Recurrence of tumor thrombus (8.3%) or bland thrombus (8.3%) are the predominant reasons for IVC occlusion after RN-VTT, and this outcome is associated with poor OS.
根治性肾切除术联合静脉肿瘤血栓切除术（RN-VTT）期间下腔静脉（IVC）重建大多采用一期修复或补片/移植物修复。我们试图系统评估接受IVC一期修复患者在短期至中期随访中的IVC通畅情况，并评估其与生存率的相关性。
对2013年1月至2018年8月期间接受RN-VTT的患者进行回顾性研究。对患者进行随访直至死亡、最后一次可用随访或2022年3月。使用随访横断面成像研究通畅情况和IVC直径。采用χ检验、学生t检验和Kaplan-Meier生存分析。
纳入77例患者。平均年龄为59.2±12.2岁，45.4%患者的梅奥分类为III级血栓或更高。中位随访时间为36.5个月（13.3 - 60.7个月），3年总生存率（OS）为64%。60例患者接受了IVC一期修复，其中48例患者接受了IVC通畅情况评估。10例患者（20.8%）出现腔静脉闭塞，原因包括肿瘤复发（8.3%）、新发单纯性血栓（8.3%）或狭窄（4.2%）。IVC通畅似乎是OS的一个重要预测因素（风险比，2.85；P = 0.021）。虽然术后3个月扫描时肾下（P = 0.019）、肾（P < 0.001）和肾上（P < 0.001）水平的IVC直径显著减小，但在长期随访成像中并未进一步减小。
一期修复IVC重建的总体通畅率为80.2%，狭窄率仅为4.0%。肿瘤血栓复发（8.3%）或单纯性血栓（8.3%）是RN-VTT后IVC闭塞的主要原因，这一结果与较差的OS相关。
