Surgical outcomes for older patients with renal cell carcinoma and inferior vena cava thrombus

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Urol Oncol. 2022 Jan 10:S1078-1439(21)00563-9. doi: 10.1016/j.urolonc.2021.12.013. Online ahead of print.


OBJECTIVES: To compare the surgical and oncological outcomes of older patients undergoing surgery for renal cell carcinoma (RCC) with a tumor in the inferior vena cava (IVC) and those of younger patients.

MATERIALS AND METHODS: We retrospectively evaluated 123 patients who underwent surgery for RCC-IVC at two institutions between 2008 and 2019. We classified them into the ≥70 years and the <70 years group, based on their age during surgery. The patients’ perioperative outcomes as well as survival (overall survival [OS] and cancer-specific survival [CSS]) were evaluated and compared before and after 1:1 propensity score matching. Sensitivity analyses were performed at age thresholds of 75 and 80 years.

RESULTS: The ≥70 and the <70 groups comprised 43 and 80 patients, respectively. Most patients in the ≥70 group demonstrated an American Society of Anesthesiologists score of 2 or 3. They were more likely to have a statistically insignificant high (≥3) Charlson Comorbidity index score (16.3 vs. 6.3%) and a lower hemoglobin level (10.4 vs. 11.7 g/dL) than the <70 group. Eighteen (41.9%) and 32 (40.0%) patients had at least one distant metastasis at the time of surgery in the ≥70 and <70 group, respectively. The complication rates (any grade and grade ≥3), the length of hospitalization, readmission rates, and mortality were comparable between the groups, both before and after matching (all, non-specific). There was no statistically significant difference in the OS (median 66.6 vs. not reached [N.R.], P = 0.695) or CSS (N.R. vs. N.R., P = 0.605) between the groups before matching. The OS and CSS results were similar and comparable following matching (both, non-specific). Further, OS and CSS were comparable between the ≥75 and <75 groups, and between the ≥80 and <80 age groups, respectively.

CONCLUSION: The surgical outcomes of older patients with RCC-IVC were not inferior to those of younger patients. With careful patient selection, surgery can still be a treatment option.

PMID:35027262 | DOI:10.1016/j.urolonc.2021.12.013