Yunhe Guan, Ye Yan, Ruiyang Xie, Liyuan Ge, Xiaojun Tian, Guoliang Wang, Lulin Ma, Hongxian Zhang, Shudong Zhang
In overlap patients, no statistically significant differences in renal or safety/recovery outcomes were observed, but neither renal non-inferiority nor equivalence was established. Planning should consider thrombus-wall interaction, caval patency, collateral outflow, and renal reserve.
PURPOSE: IVC segmental resection (SR) during robot-assisted radical nephrectomy and IVC thrombectomy (RARN-IVCT) is selected for wall invasion, occlusion, and collateral outflow, making direct comparison with non-segmental resection (NSR) biased. We compared the perioperative and renal safety of SR versus NSR in the overlap population.
METHODS: Retrospective single-center cohort at Peking University Third Hospital (2014-2025): 120 patients with RCC and Mayo level II-IV IVC thrombus undergoing RARN-IVCT, including 45 SR and 75 NSR. Overlap weighting balanced baseline variables. Primary outcomes were AKI, ΔSCr, and ΔeGFR; secondary outcomes were complications and hospital stay, with OS assessed exploratorily.
RESULTS: After weighting, no statistically significant differences were observed in AKI, ΔSCr, ΔeGFR, complications, hospital stay, or OS. SR had lower RBC transfusion volume (mean difference - 249.63 mL, 95% CI - 443.20 to - 56.05; P = 0.011). SR met non-inferiority/equivalence for hospital stay and pneumonia; renal non-inferiority was not established. Limitations include retrospective design, limited effective sample size, and unmeasured anatomic/hemodynamic confounding.
CONCLUSION: In overlap patients, no statistically significant differences in renal or safety/recovery outcomes were observed, but neither renal non-inferiority nor equivalence was established. Planning should consider thrombus-wall interaction, caval patency, collateral outflow, and renal reserve.