Inferior vena cava ligation comparable to thrombectomy in renal cell carcinoma patients

Outcomes are similar between patients with renal cell carcinoma who underwent inferior vena cava (IVC) ligation compared to IVC thrombectomy, a study has shown.

“Patients with IVC ligation initially face a more complicated postoperative course but in the longer term have similar renal function recovery, complication rates, and survival,” the authors said.

A case-controlled, retrospective study was conducted at a high-volume single-centre institution. Twenty-six patients with renal cell carcinoma who underwent ligation without reconstruction between 2005 and 2019 were matched with 52 patients who underwent thrombectomy based on preoperative renal function, renal cell carcinoma stage, and intraoperative thrombus level.

Compared to thrombectomy, ligation resulted in higher rates of 90-day readmission (19 percent vs 4 percent; p=0.025), postoperative complication (73 percent vs 39 percent; p=0.004), and lymphedema (23 percent vs 8 percent; p=0.055).

However, the rates of persistent overall (49 percent vs 31 percent; p=0.497) and major complications (8 percent vs 8 percent; p=1.000) for both ligation and thrombectomy groups turned out to be similar by 1-month follow-up. At 18-month follow-up, mean estimated glomerular filtration rate declines were also comparable between the ligation (8.5 ml/min/1.73 m²) and thrombectomy groups (9.9 ml/min/1.73 m²; p=0.834).

Additionally, there were no statistically significant differences in cancer-specific (p=0.993) and all-cause mortality (p=0.756).

“Radical nephrectomy with tumour thrombectomy is considered standard of care in patients with renal cell carcinoma. However, surgical ligation and interruption of the IVC is sometimes necessary when the tumour thrombus invades the IVC wall,” the authors said.