Complications of Tumor Nephrectomy with and Without Tumor Thrombus in the Vena Cava, Recorded with the Clavien–Dindo Classification: A Matched-Pair Analysis
1
Department of Urology, Jena University Hospital, 07747 Jena, Germany
2
Comprehensive Cancer Center Central Germany (CCCG), 07743 Jena, Germany
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(20), 3523; https://doi.org/10.3390/cancers16203523
Submission received: 2 September 2024
/
Revised: 8 October 2024
/
Accepted: 12 October 2024
/
Published: 18 October 2024
(This article belongs to the Special Issue Optimizing Surgical Procedures and Outcomes in Renal Cancer)
Simple Summary
This study looked at the complications that can occur following nephrectomies for kidney cancer with and without a so-called tumor thrombus, a tumor that has spread into the large vein called the inferior vena cava. So far, insufficient data are available on this topic. We developed a new way to classify the different types of complications, which, along with the established Clavien–Dindo classification, helped to better analyze these complications. We reviewed the data of 88 patients and found that the 44 patients with a tumor thrombus experienced significantly more and more severe complications than the 44 patients without a tumor thrombus. These results highlight the importance of having these complicated surgeries performed in specialized hospitals by experienced urologists and skilled staff. This practice could lead to earlier detection, better prevention, and more effective treatment of any complications arising after such surgeries. Consequently, the research findings could improve clinical practice and optimize treatment outcomes for patients undergoing nephrectomies.
Abstract
Background/Objectives: Radical nephrectomy (RN) with inferior vena cava thrombectomy (IVCT) is indicated for the curative management of renal cell carcinoma (RCC) with tumor thrombus (TT). In the literature, any direct comparison of complications between RNs with or without IVCT is lacking. The objective of this study was to analyze and compare complications after RNs with or without IVCT. Methods: A retrospective evaluation of the complications recorded in RCC patients who underwent RN with (TT group, n = 44) or without (non-TT group, n = 44) IVCT between 2009 and 2021 was conducted. The non-TT group was identified via propensity-score matched-pair analysis. Postoperative complications up until discharge or postoperative day 30, whichever came first, were classified using the Clavien–Dindo classification (CDC). Complications were categorized into cardiovascular, pulmonary, bleeding, gastrointestinal, neurological/psychiatric, wound, urinary tract, dysglycemia, and other groups. Statistical analyses using descriptive statistics included the chi2 and Mann–Whitney U tests. Results: All CDC-grade postoperative complications were more frequent in the TT than in the non-TT group regarding the number of patients affected (93% vs. 73%), as well as per patient (median: 3 vs. 1; p < 0.001). Complications in CDC grade ≥ 3 were rare and comparable between groups. Cardiovascular, gastrointestinal, neurological/psychiatric, and bleeding complications occurred significantly more often in the TT group. However, its small study population and retrospective character limit this study. Conclusions: Significantly more patients undergoing an RN-IVCT experience more frequent postoperative complications than patients with an RN but without IVCT. Surgeons performing the procedures should be experienced, and hospital staff should be trained in the early recognition and treatment of complications.
