Key result
Modified level III IVC tumor thrombus classification shows no benefit for predicting perioperative outcomes.
Why the study?
Ambiguity in the definition of level III inferior vena cava tumor thrombus limits comparisons between open and minimally-invasive surgical series.
Does a modified classification system for IVC tumor thrombus improve prediction of perioperative outcomes in patients undergoing radical nephrectomy?
Cohort (n=253)
Does a modified classification system for IVC tumor thrombus improve prediction of perioperative outcomes in patients undergoing radical nephrectomy?
Effect estimate: AUCs 0.59-0.58; 0.61-0.61; 0.72-0.72
A modified classification system for IVC tumor thrombus did not meaningfully improve the prediction of perioperative outcomes, though standardization of the level III thrombus border is advocated.
Proposed modified IVC-TT classification may refine risk estimates; leaves open need for prospective validation before clinical adoption.
Ambiguity exists regarding the definition of a level III inferior vena cava tumor thrombus (IVC-TT), limiting comparisons between open and minimally-invasive series. We assessed 253 patients who underwent radical nephrectomy with IVC-TT from 2000-2015 and proposed a modified classification based on associations between intraoperative IVC clamp position and need for cardiopulmonary bypass with complications, length of stay, and blood transfusions. Predictive ability of the modified system was not meaningfully improved (AUCs 0.59–0.58; 0.61–0.61; 0.72–0.72). Nevertheless, we advocate for standardization of the border of a level III thrombus at or above the major hepatic veins to facilitate meaningful comparisons between techniques.
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Leibovich et al. (2020) conducted a cohort in Renal Cell Carcinoma with Inferior Vena Cava Extension (n=253). Modified classification of level III inferior vena cava tumor thrombus vs. Standard classification was evaluated on Predictive ability for complications, length of stay, and blood transfusions (AUCs 0.59-0.58; 0.61-0.61; 0.72-0.72). A modified classification system for level III inferior vena cava tumor thrombus did not meaningfully improve the prediction of perioperative complications, length of stay, or blood transfusions.
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