中国单中心大样本研究：肿瘤栓形态对肾细胞癌伴下腔静脉瘤栓手术复杂性的影响。

Influence of tumor thrombus morphology on the surgical complexity in renal cell carcinoma with inferior vena cava tumor thrombus: a single-center, large-sample study from China.

机构信息

Department of Urology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China.

Department of Urology, Yan'an Hospital of Traditional Chinese Medicine, 26 Xuanyuan Road, Bridge Ditch Street, Baota District, Yan'an, Shanxi Province, 716000, China.

出版信息

World J Urol. 2024 Jul 29;42(1):454. doi: 10.1007/s00345-024-05170-3.

DOI:10.1007/s00345-024-05170-3

PMID:39073634

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11286623/

Abstract

BACKGROUND

The morphology of tumor thrombus varies from person to person and it may affect surgical methods and tumor prognosis. However, studies on the morphology of tumor thrombus are limited. The purpose of our study was to evaluate the impact of tumor thrombus morphology on surgical complexity.

METHODS

We retrospectively reviewed the clinical data of 229 patients with renal cell carcinoma combined with inferior vena cava (IVC) tumor thrombus who underwent surgical treatment at Peking University Third Hospital between January 2014 and December 2021. The patients were divided into floating morphology (107 patients) and filled morphology (122 patients) tumor thrombi groups. Chi-square and Mann-Whitney U tests were used for categorical and continuous variables, respectively. Postoperative complications were evaluated using the Clavien-Dindo surgical complication classification method.

RESULTS

Patients with filled morphology tumor thrombus required more surgical techniques than those with floating morphology tumor thrombus, which was reflected in more open surgeries (P < 0.001), more IVC interruptions (P <0.001), lesser use of the delayed occlusion of the proximal inferior vena cava (DOPI) technique (P < 0.001), and a greater need for cut-off of the short hepatic vein (P < 0.001) and liver dissociation (P = 0.001). Filled morphology significantly increased the difficulty of surgery in patients with renal cell carcinoma with tumor thrombus, reflected in longer operation time (P < 0.001), more surgical blood loss (P <0.001), more intra-operative blood transfusion (P < 0.001), and longer postoperative hospital stay (P < 0.001). Filled morphology tumor thrombus also led to more postoperative complications (53% vs. 20%; P < 0.001).

CONCLUSION

Compared with floating morphology thrombus, filled morphology thrombus significantly increased the difficulty of surgery in patients with renal cell carcinoma with IVC tumor thrombus.

摘要

背景

肿瘤栓子的形态因人而异，可能会影响手术方法和肿瘤预后。然而，目前对肿瘤栓子形态的研究还很有限。本研究旨在评估肿瘤栓子形态对手术复杂性的影响。

方法

我们回顾性分析了 2014 年 1 月至 2021 年 12 月期间在北京大学第三医院接受手术治疗的 229 例肾细胞癌合并下腔静脉（IVC）肿瘤栓子患者的临床资料。患者分为漂浮形态（107 例）和填充形态（122 例）肿瘤栓子组。采用卡方检验和曼-惠特尼 U 检验分别对分类变量和连续变量进行分析。采用 Clavien-Dindo 手术并发症分级方法评估术后并发症。

结果

填充形态肿瘤栓子患者比漂浮形态肿瘤栓子患者需要更多的手术技术，这体现在更多的开放手术（P < 0.001）、更多的 IVC 中断（P < 0.001）、更少使用延迟阻断下腔静脉近端（DOPI）技术（P < 0.001）、更需要切断短肝静脉（P < 0.001）和肝离断（P = 0.001）。填充形态显著增加了肾细胞癌伴肿瘤栓子患者的手术难度，表现为手术时间更长（P < 0.001）、手术出血量更多（P < 0.001）、术中输血更多（P < 0.001）和术后住院时间更长（P < 0.001）。填充形态肿瘤栓子还导致更多的术后并发症（53% vs. 20%；P < 0.001）。