MP30-16 EARLY UNCLAMPING IN LAPAROSCOPIC PARTIAL NEPHRECTOMY IMPROVES EARLY ESTIMATED GLOMERULAR FILTRATION REDUCTION RATE

Abstract

The aim of this study was to analyze the impact on survival of microscopic venous wall (renal vein and inferior vena cava) invasion in a series of patients with RCC and venous extension. METHODS: We conducted a retrospective review of 1974 patients with RCC and vena cava thrombus between 1971 and 2012 in 22 of Europe and USA . Kaplan Meier and a multivariate logistic regression analyses were used to assess the impact of microscopic invasion of the renal vein and cava on cancer-specific survival (CSS), We also analyzed other clinicopathological factors as F€ uhrman grade, thrombus level, perirenal fat invasion, sarcomatoid features and tumor necrosis. RESULTS: With a mean follow-up of 42.45 months CSS was 42.7 %. One hundred thirty-one (18.8%) patients had microscopic invasion of the vena cava wall (MIVC) and 295 microscopic invasion of the renal vein wall (MIRV). According to the Mayo Clinic classification, 309 (15.7 %) patients had level I tumor thrombus,, 360 (18.2 %) level II, 213 (10.8 %) level III and 173 (8.8 %) level IV . In the univariate analysis, the MIVC and MIRV (p: 0.015), higher Fuhrman (p < 0.001), perirenal fat invasion (p < 0.001) and presence of multifocal disease ( p < 0.001) were significantly correlated with worse CSS. In multivariable analysis, the MIVC (HR 1.7 CI 1.1-2.5, p: 0.009), Fuhrman grade (HR: 2.1 CI 1.3-3-4, p.0.002) and perirenal fat invasion (HR 2.1 CI 1.4 3-3, p < 0.0001) were confirmed as predictors of CSS. CONCLUSIONS: In addition to other factors known as Fuhrman grade and perirenal fat invasion, the MIVC is an independent prognostic factor of survival in RCC with vena cava thrombus.