Impact of presurgical systemic therapy on perioperative outcomes of renal cell carcinoma with inferior vena cava tumor thrombus.

Abstract

Surgery for inferior vena cava tumor thrombus (IVC-TT) in patients with renal cell carcinoma (RCC) is highly invasive and is associated with perioperative mortality. This study aimed to assess the efficacy of presurgical systemic therapy (PT) on perioperative outcomes in RCC patients with IVC-TT. A total of 68 patients with right-sided RCC and level ≥ II IVC-TT were included in this study. The tumor response to PT was investigated, and we compared surgical outcomes and perioperative complications between patients with PT (n = 23) and those who underwent immediate surgical resection (non-PT, n = 45). In the PT group, while 15 patients were treated with tyrosine kinase inhibitors (TKIs) alone, a combination of immune-oncology (IO) therapy and TKIs (IO + TKI) was used in 8 patients. Eleven of 23 (47.8%) patients in the PT group showed a reduction in the level of TT. PT significantly reduced the operation time, intraoperative blood loss, the need for extracorporeal circulation, the incidence of grade ≥ III perioperative complications, and the duration of hospitalization after surgery. Our findings suggest that PT may be effective in reducing surgical invasiveness in RCC patients with IVC-TT. Further prospective studies are needed to identify the optimal drug regimen for PT and to clarify its survival benefits.