Postoperative Mortality in Renal Cell Carcinoma with Vena Cava Thrombus in the Elderly Population (uroCCR study n°192)

Abstract Purpose : Inferior vena cava (IVC) thrombus is a severe presentation of renal cell carcinoma (RCC), traditionally treated with radical nephrectomy and thrombus extraction. However, the benefit-risk balance in elderly patients remains unclear due to limited data. This study aimed to assess surgical outcomes—particularly 90-day mortality—in patients aged ≥ 70 year and identify risk factors for postoperative mortality. Methods: We retrospectively analyzed data from the prospective French UroCCR national cohort (2007–2023), including 298 patients with RCC with IVC thrombus who underwent surgery in 13 expert centers. Patients were stratified into ≥ 70 vs. <70 year. The primary endpoint was 90-day mortality. Secondary outcomes included overall survival (OS), disease-specific survival (DSS), and predictors of postoperative 90-d death. Statistical analyses included univariate and multivariate logistic regression adjusted for sex, ASA score, and eGFR. Results: Among the 117 elderly patients, 90-d mortality was 8.5% vs. 5.5% in younger patients (p = 0.33). In those aged ≥ 80 year (n = 32), 90-d mortality reached 19% (p = 0.02). Impaired eGFR < 45 mL/min was the only significant predictor of postoperative death (OR 3.9, p = 0.04). Long-term DSS was comparable between age groups. Study limitations include its retrospective design and inclusion of only surgical candidates. Conclusions: Radical nephrectomy with thrombus extraction yields acceptable outcomes in patients aged ≥ 70 year, though ≥ 80 year face higher perioperative risk. Careful selection—including renal function evaluation—is crucial. DSS equivalence suggests age alone should not contraindicate surgery.