PD56: Kidney Cancer: Localized: Surgical Therapy IV
PD56-10: The important role of tumor volume on the surgical approach choice, surgical complexity, and postoperative complications in renal cell carcinoma with venous tumor thrombus from a large Chinese center experience
Objective: To explore the role of tumor volume (TV) on surgical approach choice, surgical complexity and postoperative complications in patients with renal cell carcinoma (RCC) and inferior vena cava tumor thrombus.
Method: From January 2014 to January 2020, we retrospectively reviewed clinical data of 132 patients who underwent radical nephrectomy with inferior vena cava thrombectomy (RN-IVCT) and measured 3D volume of primary renal tumor volume (PRTV), renal vein tumor thrombus volume (RVTTV), inferior vena cava tumor thrombus volume (IVCTTV), total tumor thrombus volume (TTTV) and total tumor volume (TTV). Patients were divided into three groups according to the IVCTTV size. One-Way ANOVA was used to compare the clinicopathological characteristics of the three groups. Nonparametric test was used to compare the distribution differences between the three groups. Chi-square test was used for continuous variables.
Results: Group 1 comprised of 48 patients with IVCTTV between 0-15 cm3 (36.6%), group 2 comprised of 38 patients with IVCTTV between 15-30 cm3(28%), and group 3 comprised of 46 patients with IVCTTV over 30 cm3 (35%). Patients with large tumor volume had higher proportion of open surgery (P <0.001), longer operative time (P <0.044), more intra-operative blood loss (P <0.001), and higher incidence of post-operative complications (P <0.001). IVCTTV and TTTV (P <0.001) were independent factors for surgical approach choice (P <0.001). RVTTV (P <0.014), IVCTTV (P <0.033), and TTTV (P <0.005) were independent factors for operative time, and IVCTTV and TTTV were independent factors for intra-operative blood loss (P <0.001).
Conclusion: Larger tumor volume necessitates open surgery and is associated with increased surgical complexity and higher incidence of post-operative complications. However, TV does not effect prognosis.