Frölich Ute Maria, Leucht Katharina, Grimm Marc-Oliver, Foller Susan
Department of Urology, Jena University Hospital, 07747 Jena, Germany.
Comprehensive Cancer Center Central Germany (CCCG), 07743 Jena, Germany.
Cancers (Basel). 2024 Oct 18;16(20):3523. doi: 10.3390/cancers16203523.
BACKGROUND/OBJECTIVES: Radical nephrectomy (RN) with inferior vena cava thrombectomy (IVCT) is indicated for the curative management of renal cell carcinoma (RCC) with tumor thrombus (TT). In the literature, any direct comparison of complications between RNs with or without IVCT is lacking. The objective of this study was to analyze and compare complications after RNs with or without IVCT.
A retrospective evaluation of the complications recorded in RCC patients who underwent RN with (TT group, = 44) or without (non-TT group, = 44) IVCT between 2009 and 2021 was conducted. The non-TT group was identified via propensity-score matched-pair analysis. Postoperative complications up until discharge or postoperative day 30, whichever came first, were classified using the Clavien-Dindo classification (CDC). Complications were categorized into cardiovascular, pulmonary, bleeding, gastrointestinal, neurological/psychiatric, wound, urinary tract, dysglycemia, and other groups. Statistical analyses using descriptive statistics included the chi and Mann-Whitney U tests.
All CDC-grade postoperative complications were more frequent in the TT than in the non-TT group regarding the number of patients affected (93% vs. 73%), as well as per patient (median: 3 vs. 1; < 0.001). Complications in CDC grade ≥ 3 were rare and comparable between groups. Cardiovascular, gastrointestinal, neurological/psychiatric, and bleeding complications occurred significantly more often in the TT group. However, its small study population and retrospective character limit this study.
Significantly more patients undergoing an RN-IVCT experience more frequent postoperative complications than patients with an RN but without IVCT. Surgeons performing the procedures should be experienced, and hospital staff should be trained in the early recognition and treatment of complications.
背景/目的：根治性肾切除术（RN）联合下腔静脉血栓切除术（IVCT）适用于治疗伴有肿瘤血栓（TT）的肾细胞癌（RCC）。在文献中，缺乏对有或无IVCT的RN术后并发症的直接比较。本研究的目的是分析和比较有或无IVCT的RN术后并发症。
对2009年至2021年间接受RN联合（TT组，n = 44）或不联合（非TT组，n = 44）IVCT的RCC患者记录的并发症进行回顾性评估。非TT组通过倾向评分匹配对分析确定。使用Clavien-Dindo分类法（CDC）对出院前或术后30天（以先到者为准）的术后并发症进行分类。并发症分为心血管、肺部、出血、胃肠道、神经/精神、伤口、泌尿系统、血糖异常和其他组。使用描述性统计的统计分析包括卡方检验和Mann-Whitney U检验。
就受影响患者数量（93%对73%）以及每位患者而言（中位数：3对1；P < 0.001），所有CDC分级的术后并发症在TT组比非TT组更频繁。CDC≥3级并发症很少见且两组之间相当。心血管、胃肠道、神经/精神和出血并发症在TT组中发生得明显更频繁。然而，本研究样本量小且具有回顾性，限制了本研究。
与接受RN但未接受IVCT的患者相比，接受RN-IVCT的患者术后并发症明显更频繁。实施手术的外科医生应经验丰富，医院工作人员应接受并发症早期识别和治疗的培训。
