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Purpose <p>We aimed to evaluate perioperative and oncological outcomes in renal cell carcinoma (RCC) with tumor thrombus (TT) patients undergoing inferior vena cava (IVC) segmental resection, with comparative analysis stratified by surgical approaches.</p> Methods <p>A retrospective analysis was conducted on 271 RCC with TT patients. Patients’ clinicopathological data were collected. Continuous variable comparisons utilized the Wilcoxon rank-sum test or unpaired <i>t</i>-tests based on their distribution, while categorical variable analyses employed the Chi-square test. Survival outcomes were evaluated through Kaplan–Meier estimation.</p> Results <p>Overall, 123 patients (45.4%) experienced IVC segmental resection. Despite exhibiting poorer preoperative renal function, the segmental resection group achieved comparable postoperative estimated glomerular filtration rate (eGFR) as the control group (56.7 vs. 55.7 mL/min/1.73m<sup>2</sup>; <i>p</i>&#xa0;=&#xa0;0.10). The overall (51.2% vs. 41.9%; <i>p</i>&#xa0;=&#xa0;0.12) and major (6.5% vs. 6.1%; <i>p</i>&#xa0;=&#xa0;0.89) complication rates also showed no significant difference. Robot-assisted segmental resection demonstrated superior perioperative outcomes versus open surgery: shorter postoperative hospital stay (7 vs. 10 days; <i>p</i>&#xa0;&lt;&#xa0;0.01), reduced operative time (237 vs. 371 min; <i>p</i>&#xa0;&lt;&#xa0;0.01), and less blood loss (700 vs. 1500&#xa0;mL; <i>p</i>&#xa0;&lt;&#xa0;0.01). Compared with laparoscopic surgery, robot-assisted segmental resection reduced postoperative hospital stay (7 vs. 11.5 days; <i>p</i>&#xa0;&lt;&#xa0;0.01) and operative time (236.5 vs. 421.5 min; <i>p</i>&#xa0;&lt;&#xa0;0.01). Overall survival showed no significant difference between the IVC segmental and non-segmental resection cohorts.</p> Conclusion <p>Segmental resection of the IVC represents a safe and technically feasible intervention in RCC patients with TT, demonstrating acceptable perioperative safety in appropriately selected cases. Robot-assisted techniques significantly reduced procedural complexity and optimized perioperative outcomes.</p>

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Segmental Resection of the Inferior Vena Cava is Safe and Feasible for Patients with Renal Cell Carcinoma with Tumor Thrombus: A Large-Scale Retrospective Study from a High-Volume Center

  • 期刊论文

  • 发表日期：

    2025年9月22日

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  • Le Yu,
  • Weiliang Zhang,
  • Peichen Duan,
  • Fan Zhang,
  • Shaohui Deng,
  • Ye Yan,
  • Zhou Liu,
  • Yimeng Song,
  • Guoliang Wang,
  • Hongxian Zhang,
  • Peng Hong,
  • Shudong Zhang

摘要

Purpose

We aimed to evaluate perioperative and oncological outcomes in renal cell carcinoma (RCC) with tumor thrombus (TT) patients undergoing inferior vena cava (IVC) segmental resection, with comparative analysis stratified by surgical approaches.

Methods

A retrospective analysis was conducted on 271 RCC with TT patients. Patients’ clinicopathological data were collected. Continuous variable comparisons utilized the Wilcoxon rank-sum test or unpaired t-tests based on their distribution, while categorical variable analyses employed the Chi-square test. Survival outcomes were evaluated through Kaplan–Meier estimation.

Results

Overall, 123 patients (45.4%) experienced IVC segmental resection. Despite exhibiting poorer preoperative renal function, the segmental resection group achieved comparable postoperative estimated glomerular filtration rate (eGFR) as the control group (56.7 vs. 55.7 mL/min/1.73m2; p = 0.10). The overall (51.2% vs. 41.9%; p = 0.12) and major (6.5% vs. 6.1%; p = 0.89) complication rates also showed no significant difference. Robot-assisted segmental resection demonstrated superior perioperative outcomes versus open surgery: shorter postoperative hospital stay (7 vs. 10 days; p < 0.01), reduced operative time (237 vs. 371 min; p < 0.01), and less blood loss (700 vs. 1500 mL; p < 0.01). Compared with laparoscopic surgery, robot-assisted segmental resection reduced postoperative hospital stay (7 vs. 11.5 days; p < 0.01) and operative time (236.5 vs. 421.5 min; p < 0.01). Overall survival showed no significant difference between the IVC segmental and non-segmental resection cohorts.

Conclusion

Segmental resection of the IVC represents a safe and technically feasible intervention in RCC patients with TT, demonstrating acceptable perioperative safety in appropriately selected cases. Robot-assisted techniques significantly reduced procedural complexity and optimized perioperative outcomes.