Management of renal cancer with inferior vena cava extension over 30 years: a bi-centric study.

Abstract

Purpose: In 5-10% of cases, renal cancer extends into the venous system, particularly the inferior vena cava (IVC), which worsens prognosis. This study aims to assess morbidity, mortality, and oncological outcomes of patients treated surgically for renal cancer with IVC extension over a 30-year period, in two experienced centers.

Materials and methods: This bicentric, retrospective study analyzed patients treated between 1988 and 2020 for renal cancer involving the IVC. Surgical approach varied based on thrombus level, with CPB mostly employed for thrombi above the hepatic veins.

Results: From 1988 to 2020, 213 patients were treated. Thrombi below the hepatic veins were found in 137 patients (64.3%), while 76 (35.7%) had thrombi above the hepatic veins. Synchronous metastases were identified in 34.3%. Median blood loss was 1.75 L. Transfusions were required in 81.8%.CPB use significantly extended hospital stay (p < 0.001) and increased complication rates (p < 0.01). Morbidity was recorded in 53% of patients. Postoperative mortality within 30 days occurred in 9.4% of cases. Median follow-up was 25 months. The 2- and 5-year OS rates were 50.2% and 29.6%, respectively. In multivariate analysis, M + and pN + status at diagnosis were the primaries prognostics factors for OS (HR = 1.54, p = 0.033 and HR = 2.21, p = 0.002). The 2 and 5 years PFS were 25.3% and 11.7%, respectively.

Conclusion: Renal cancer with IVC extension remains a highly aggressive disease with poor prognosis. While surgery offers a potential cure for some patients, the high rates of perioperative morbidity and mortality remain a challenge.