Bertail Théophile, Khene Zine-Eddine, Fleury Raphaël, Waeckel Thibault, Surlemont Louis, Bruyère Franck, Doumerc Nicolas, Bigot Pierre, Rouprêt Morgan, Bernhard Jean-Christophe, Bensalah Karim
Department of Urology, CHU Rennes, Rennes, France.
Department of Urology, CHU Caen Normandie, Caen, France.
Eur Urol Open Sci. 2025 Aug 26;80:14-20. doi: 10.1016/j.euros.2025.08.002. eCollection 2025 Oct.
Surgery of renal cell cancer (RCC) with a caval thrombus (CT) is associated with significant morbidity, particularly regarding thromboembolic complications. There are no data or recommendations regarding the potential benefit of preoperative anticoagulants. We aimed to assess the usefulness of preoperative anticoagulation regarding surgical outcomes and thromboembolic events in patients undergoing nephrectomy with inferior vena cava thrombectomy.
We conducted a multicenter retrospective study of 216 patients who underwent surgery for RCC with a CT. Of these patients, 114 had preoperative anticoagulants. Intraoperative data and postoperative complications, particularly thromboembolic events, were compared between the two groups. To account for potential selection biases arising from nonrandom allocation of patients to different groups, we performed a propensity score-matched analysis.
There were more overall and major complications in the anticoagulation group, but the difference became nonsignificant after matching (odds ratio [OR] 1.58; 95% confidence interval or CI [0.76-3.26]; = 0.17 and OR 1.83; 95% CI [0.68-4.96]; = 0.21 respectively). Other pre- and postoperative parameters, particularly thromboembolic events, did not differ between the two groups. The main limitations are the retrospective design and the intercenter variability.
The prescription of anticoagulation at the time of diagnosis of RCC with a CT does not appear to have any influence on the occurrence of thromboembolic events, while potentially increasing morbidity.
Surgery for kidney tumors with a caval thrombus is difficult and associated with a high rate of complications. One of the most feared complications is pulmonary embolism. Our study suggests that prescribing anticoagulants before surgery does not decrease the risk of embolism and could be responsible for an increased rate of complications.
伴有腔静脉血栓（CT）的肾细胞癌（RCC）手术具有较高的发病率，尤其是血栓栓塞并发症方面。目前尚无关于术前使用抗凝剂潜在益处的数据或建议。我们旨在评估术前抗凝对于接受肾切除术并同时行下腔静脉血栓切除术患者的手术结局和血栓栓塞事件的作用。
我们对216例接受伴有CT的RCC手术的患者进行了一项多中心回顾性研究。其中114例患者术前使用了抗凝剂。比较两组患者的术中数据和术后并发症，尤其是血栓栓塞事件。为了考虑因患者非随机分配至不同组而产生的潜在选择偏倚，我们进行了倾向评分匹配分析。
抗凝组的总体并发症和严重并发症更多，但匹配后差异无统计学意义（优势比[OR]1.58；95%置信区间[CI][0.76 - 3.26]；P = 0.17，以及OR 1.83；95% CI[0.68 - 4.96]；P = 0.21）。两组之间的其他术前和术后参数，尤其是血栓栓塞事件，并无差异。主要局限性在于回顾性设计和中心间的变异性。
诊断为伴有CT的RCC时使用抗凝剂似乎对血栓栓塞事件的发生没有任何影响，同时可能增加发病率。
伴有腔静脉血栓的肾肿瘤手术难度大且并发症发生率高。最令人担忧的并发症之一是肺栓塞。我们的研究表明，术前使用抗凝剂并不能降低栓塞风险，反而可能导致并发症发生率增加。
