Abstract
Objective
To provide insight into the surgical and oncological outcomes of robotic, laparoscopic and open radical nephrectomy with venous thrombectomy (RALRN-VT, LRN-VT, ORN-VT) in patients with renal tumor and venous thrombus.
Materials and Methods
A propensity-matched retrospective cohort study containing 324 patients with renal tumor and venous thrombus from January 2014 to August 2021 was analyzed. We compared surgical outcomes and we used the Kalan-Meier method to assess the overall survival (OS), tumor-specific survival (TSS), metastasis-free survival (MFS) and local recurrence-free survival (LRFS). The Pearson chi-square test and Fisher exact test, Wilcoxon rank sum test, Cox proportional hazards regression model and log-rank test were used.
Results
After matching, baseline characteristics were comparable in the RALRN-VT, LRN-VT and ORN-VT group. The RALRN-VT group had the least operative time (median 134 min vs 289 min vs 330 min, P < 0.001), the least blood loss (median 250 ml vs 500 ml vs 1000 ml, P < 0.001) and the fewest packed red blood cells transfusion (median 400 ml vs 800 ml vs 1200 ml, P < 0.001). The ORN-VT group had the highest complication rate (18.2 vs 22.7 vs 43.2%, P = 0.005), the highest Clavien grade (P = 0.001) and the longest postoperative hospital stay (median 7d vs 8d vs 10d, P < 0.001). No significant difference in OS, TSS and MFS between the minimally invasive procedures (MIP, including RALRN-VT and LRN-VT) group and ORN-VT group was found. The hazard ratio of LRFS for the MIP group was 0.20 (95% CI 0.06–0.70, P = 0.01) compared with ORN-VT group.
Conclusions
RALRN-VT can result in the best surgical outcomes compared with LRN-VT and ORN-VT. The MIP group had a better LRFS compared with ORN-VT group.
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Acknowledgements
We thank all the staff of department of urology in the Peking University Third Hospital. We also thank Mr. JiaJu Huang, who was the founder of BEYOND band. His music has inspired us to pursue the truth, freedom and essential nature of science in the past twenty years.
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National Nature Science Foundation of China (81972381).
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YZ Study design/Project development/Data analysis/Manuscript writing-original draft, HB Manuscript writing-reviewing/Project development/Critical revision YY Manuscript writing-reviewing/Project development/Critical revision, ZL Data collection/Supervision, GW Supervision, YS Material support SZ Supervision/Critical revision, CL Supervision/Critical revision, LLM Study design/Supervision/ Critical revision/ Material support/Funding acquision.
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Zhang, Y., Bi, H., Yan, Y. et al. Comparative analysis of surgical and oncologic outcomes of robotic, laparoscopic and open radical nephrectomy with venous thrombectomy: a propensity-matched cohort study. Int J Clin Oncol 28, 145–154 (2023). https://doi.org/10.1007/s10147-022-02265-y
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DOI: https://doi.org/10.1007/s10147-022-02265-y