Comparative analysis of survival rates in patients with renal cell carcinoma and level i-ii tumor thrombus of the renal vein and inferior vena cava undergoing open versus laparoscopic surgical treatment

Objective. To compare recurrence-free survival and long-term oncological outcomes in patients with Renal Cell Carcinoma (RCC) and level I–II tumor thrombus of the renal vein and inferior vena cava undergoing laparoscopic versus open nephrectomy with thrombectomy. Materials and Methods. 100 patients with histologically confirmed RCC and level I–II tumor thrombus of the renal vein and inferior vena cava (according to Mayo classification) treated at the A.M. Granov Russian Research Center for Radiology and Surgical Technologies from 2007 to 2024 were included into this retrospective study. Fifty patients underwent open surgery and in fifty patients laparoscopic procedures were performed, with stratification based on clinical and morphological parameters. Progression-free survival served as the primary endpoint. Kaplan – Meier analysis and Cox proportional hazards regression were used to assess prognostic factors. Results. Mean progression-free survival was 58.9±4 months in the open surgery group versus 59.1 ± 4 months in the laparoscopic group; the differences were not statistically significant (c2=0.2916; p=0.5892; HR=0.84; 95% CI: 0.43–1.61). Lymph node metastasis (N1) was associated with significantly worse survival (HR=24.80; p0.0001). Advanced thrombus (level II) was an independent negative prognostic factor (HR=7.79; p0.0001). Conclusions. Laparoscopic nephrectomy with thrombectomy for RCC patients with level 0-II venous tumor thrombus demonstrated oncological outcomes comparabl to open surgery and may be considered an acceptable alternative when adhering to oncological principles. Lymph node involvement and thrombus extent remain key prognostic factors affecting recurrence-free survival.