Mp10-13 Safety and Efficacy of Surgery in Metastatic and Non-Metastatic Renal Cell Carcinoma With Supradiaphragmatic Tumor Thrombus Involving Cardiac Procedures

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) I (MP10)1 May 2024MP10-13 SAFETY AND EFFICACY OF SURGERY IN METASTATIC AND NON-METASTATIC RENAL CELL CARCINOMA WITH SUPRADIAPHRAGMATIC TUMOR THROMBUS INVOLVING CARDIAC PROCEDURES Edouard H. Nicaise, Yash Shah, Benjamin N. Schmeusser, Benjamin Croll, Ethan Kearns, Dattatraya Patil, Ellen Richter, McKenzie Hollon, Kenneth Ogan, Mani A. Daneshmand, Shishir K. Maithel, and Viraj A. Master Edouard H. NicaiseEdouard H. Nicaise , Yash ShahYash Shah , Benjamin N. SchmeusserBenjamin N. Schmeusser , Benjamin CrollBenjamin Croll , Ethan KearnsEthan Kearns , Dattatraya PatilDattatraya Patil , Ellen RichterEllen Richter , McKenzie HollonMcKenzie Hollon , Kenneth OganKenneth Ogan , Mani A. DaneshmandMani A. Daneshmand , Shishir K. MaithelShishir K. Maithel , and Viraj A. MasterViraj A. Master View All Author Informationhttps://doi.org/10.1097/01.JU.0001008588.39303.c9.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Invasion of the inferior vena cava (IVC) is a unique feature of renal cell carcinoma (RCC). Tumor thrombus extension into the supradiaphragmatic IVC carries high morbidity and mortality attributable to surgical complexity. It is unclear whether safety and efficacy have been shown to warrant cytoreductive surgery for metastatic RCC with concomitant thrombus. We present outcomes of cytoreductive and non-cytoreductive radical nephrectomy (RN) with supradiaphragmatic tumor thrombectomy involving cardiac surgery. METHODS: We reviewed our nephrectomy database for patients with supradiaphragmatic thrombus and confirmed RCC. RN with caval thrombectomy was performed by a single team involving urology, surgical oncology and cardiothoracic surgery. Rank Sum for numerical and chi-square for categorical variables were used to test for differences between cytoreductive and non-cytoreductive RN. Kaplan Meier curves estimated cancer-specific survival (CSS) and overall survival (OS). RESULTS: From 2006-2023, 43 patients underwent RN, of which 19 (44.2%) were cytoreductive. Table 1 indicates notable clinical and surgical features of non-mRCC and mRCC patients who received radical nephrectomy with supradiaphragmatic thrombectomy. No patient participated in a related clinical trial at the time of surgery. Operative (426 vs. 433 min, p=0.388), IVC clamp (28 vs. 33 min, p=0.714), contralateral renal vein clamp (34 vs. 26 min, p=0.225), and cardiac bypass times (61 vs. 80 minutes, p=0.515) were similar. No patient underwent circulatory arrest. There were no significant differences in Clavien grade 3+ complications (11 vs. 10), ICU length of stay (LOS; 4 vs. 3 days), total LOS (14 vs. 10 days), 90-day mortality (1 vs. 2), or readmissions (6 vs. 3). Only one patient required temporary dialysis and later passed from multi-organ failure. 5-year CSS was 12% vs. 78% (p=0.0066) and OS was 11% vs. 53% (p=0.0441) for cytoreductive and non-cytoreductive surgery respectively. CONCLUSIONS: Radical nephrectomy with supradiaphragmatic tumor thrombectomy is safe with durable treatment response in patients with non-metastatic RCC. Although safety of cytoreductive RN is comparable, further investigation into the role of neoadjuvant therapy is recommended. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e144 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Edouard H. Nicaise More articles by this author Yash Shah More articles by this author Benjamin N. Schmeusser More articles by this author Benjamin Croll More articles by this author Ethan Kearns More articles by this author Dattatraya Patil More articles by this author Ellen Richter More articles by this author McKenzie Hollon More articles by this author Kenneth Ogan More articles by this author Mani A. Daneshmand More articles by this author Shishir K. Maithel More articles by this author Viraj A. Master More articles by this author Expand All Advertisement PDF downloadLoading ...