Safety and efficacy of surgery in renal cell carcinoma with supradiaphragmatic tumor thrombus involving cardiac procedures.

Abstract

484 Background: Invasion of the IVC is a unique feature of RCC. Tumor extension into the supradiaphragmatic IVC carries high morbidity and mortality attributable to surgical complexity. It is unclear whether safety and efficacy have been shown to warrant cytoreductive surgery for metastatic RCC with concomitant thrombus. We present outcomes of cytoreductive and non-cytoreductive radical nephrectomy (RN) with supradiaphragmatic tumor thrombectomy (TT) involving cardiac surgery. Methods: We reviewed our nephrectomy database for patients with RCC and supradiaphragmatic tumor thrombus. RN with TT was performed by a single team from urology, surgical oncology and cardiothoracic surgery. Rank Sum for numerical and chi-square for categorical variables were used to test for differences between cytoreductive and non-cytoreductive RN. Kaplan Meier curves estimated cancer-specific survival (CSS) and overall survival (OS). Results: From 2006-2023, 43 patients underwent RN with supradiaphragmatic TT. The tableindicates notable clinical and surgical features. No patient participated in a related clinical trial perioperatively. No case required circulatory arrest. One patient required temporary dialysis and later passed from multi-organ failure. 5-year CSS was 12% vs. 78% (p=0.007) and OS was 11% vs. 53% (p=0.044) for cytoreductive and non-cytoreductive surgery respectively. Conclusions: RN with supradiaphragmatic TT is safe with durable treatment response in patients with non-mRCC. Although safety of cytoreductive RN is comparable, further investigation into the role of neoadjuvant therapy is recommended. [Table: see text]