Key result
Radical nephrectomy with thrombectomy carries up to ~54% risk of postoperative renal insufficiency.
Why the study?
Radical nephrectomy with thrombectomy for renal cell carcinoma with venous tumor thrombus might cause reduced renal function, but evidence on the incidence, risk factors, reasons, and influence of renal insufficiency remained unclear.
What are the incidence and risk factors for postoperative renal insufficiency in patients with RCC and VTT undergoing radical nephrectomy with thrombectomy?
Systematic Review (n=1,668)
What are the incidence and risk factors for postoperative renal insufficiency in patients with RCC and VTT undergoing radical nephrectomy with thrombectomy?
Postoperative renal insufficiency is a frequent complication after radical nephrectomy with thrombectomy for RCC with tumor thrombus, highlighting the need for careful intraoperative management and postoperative monitoring.
Wide variation in renal insufficiency rates cautions against pooled estimates; leaves open need for standardized definitions in future studies.
BACKGROUND: Renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is great burden over world. Radical nephrectomy (RN) with thrombectomy seems to be its gold standard operation, which might cause reduction of renal function. The aim of this systematic review was to provide evidence about the incidence, risk factors, possible reasons and influence of renal insufficiency in RCC patients undergoing RN with thrombectomy. METHODS: A systematic search using PubMed, Embase, Web of Science, the Cochrane Library and European Urology databases was conducted. Study selection followed the PRISMA guidelines. After screening, eleven articles and abstracted fully compatible with the PICOS were included in this systematic review. The study was registered with PROSPERO, CRD42024516596. RESULTS: Overall, a total of 1,668 patients who were diagnosed with RCC and VTT and underwent RN (open/laparoscopic/robotic) with thrombectomy were analyzed. The postoperative renal insufficiency was present from 0.7 to 53.9%. Relevant risk factors of postoperative renal insufficiency could be summarized into three aspects: baseline characteristics (male gender, tumor thrombus level), intraoperative procedure (surgical method and inferior vena cava clamping time) and other factors (development of the times). The reason of renal insufficiency could be depletion of circulation volume, alteration in renal hemodynamics and condition of solitary kidney. The overall survival (OS) ranged from 2 months to 98 months. A clear association between survival and renal function could not be established because of the oncological risk on survival. Necessary managements like supplying blood volume, diuretic therapy and renal replacement therapy should be applied. CONCLUSIONS: The present incidence of postoperative renal insufficiency was underestimated. More possible risk factors should be explored. Large cohort, multi-center, prospective, and well-designed studies would be necessary to corroborate these results and provide high-grade recommendation for clinical practice.
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Huang et al. (2025) conducted a systematic review in Renal cell carcinoma with venous tumor thrombus (n=1,668). Radical nephrectomy with thrombectomy was evaluated on Incidence of postoperative renal insufficiency. The incidence of postoperative renal insufficiency after radical nephrectomy with thrombectomy for renal cell carcinoma with venous tumor thrombus ranged widely from 0.7% to 53.9%.
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