Suprahepatic inferior vena cava clamping significantly increased operative durations, blood transfusion requirements, and the risk of postoperative thrombosis compared to lower clamping levels.
Cohort (n=84)
No
Does the level of IVC clamping and the avoidance of CPB improve perioperative outcomes and reduce thrombosis risk in patients undergoing IVC surgery?
Higher levels of IVC clamping and the use of cardiopulmonary bypass during IVC surgery are associated with increased perioperative morbidity and postoperative thrombosis.
Absolute Event Rate: 26.1% vs 5.9%
p-value: p=0.031
Purpose: This study evaluated the feasibility of radical nephrectomy and thrombectomy without cardiopulmonary bypass (CPB) in patients with renal cell carcinoma (RCC) and level IV venous tumor thrombus, compared with CPB-assisted surgery.Materials and Methods: This retrospective cohort study analyzed patients with RCC and level IV venous tumor thrombus who underwent surgery at a single center between 2014 and 2020. Feasibility of non-CPB surgery was assessed by comparing perioperative safety-related outcomes, overall survival (OS), and progression-free survival (PFS) between the non-CPB and CPB groups. Perioperative outcomes included operative time, blood loss, severe complications (Clavien-Dindo classification grade ≥III), intensive care unit (ICU) stay, and mortality. Kaplan-Meier analysis and generalized Wilcoxon tests were used to compare survival outcomes.Results: A total of 16 patients met eligibility criteria: 5 underwent surgery without CPB, and 11 underwent CPB-assisted surgery. Median operative time was similar between the CPB and non-CPB groups (490 minutes vs. 480 minutes, p=0.650). Compared with the CPB group, blood loss was lower in the non-CPB group (4000 mL vs. 1080 mL, p=0.333). Severe complications occurred in 36.4% of CPB patients and 0% of non-CPB patients (p=0.245). ICU stay was comparable between the non-CPB and CPB groups (2 days vs. 3 days, p=0.356). OS did not differ significantly between groups (p=0.180), whereas PFS was longer in the non-CPB group (p=0.041).Conclusions: Radical nephrectomy and thrombectomy without CPB appears feasible and may be associated with lower perioperative morbidity and blood loss without compromising oncologic outcomes. Non-CPB surgery should be considered in selected patients with level IV venous tumor thrombus when technically feasible.
Lim et al. (Thu,) conducted a cohort in Inferior vena cava pathology (predominantly renal cell carcinoma with thrombus) (n=84). Suprahepatic IVC clamping vs. Juxtarenal IVC clamping was evaluated on Pulmonary thromboembolism (PTE) (p=0.031). Suprahepatic inferior vena cava clamping significantly increased operative durations, blood transfusion requirements, and the risk of postoperative thrombosis compared to lower clamping levels.