Defining a threshold for safe surgical management of vena cava thrombus in renal cell carcinoma patients: evidence from German total population data with 3,700 cases from 2006 to 2020

• DOI: 10.1007/s00345-024-05360-z
• Publication Date: 2024-11-29T12:01:30Z
• Authors: Thomas Martin; Johannes Huber; Rainer Koch; Marius Butea-Bocu; Lennard Haak; Luka Flegar; Matthias Giese; Fabian Kormann; Cem Aksoy; Aristeidis Zacharis; Christer Groeben
• Keywords: Nephrology

Abstract Purpose The management of inferior vena cava (IVC) tumor thrombus in patients with renal cell carcinoma (RCC) is among the most challenging surgical procedures. We aimed to define a minimum annual caseload for sufficient expertise. Methods identified all cases RCC, nephrectomy, and IVC procedures Federal Statistical Office billing database (2006–2020). defined hospital categories as low (< 4 cases), medium (4–9 cases) high (> 9 volume. Logistic multivariate models mortality-related factors. In addition, we analyzed data on stage distribution from German cancer registries. Results recorded 3,700 nephrectomies IVC-tumor resection stable case number 247 mean. This correlated incidence T3b/c RCC. Patient age was 66 ± 14 years. Of cases, 56% occurred low, 30% medium, 14% volume clinics without significant trend towards centralization. overall in-hospital mortality rate 5.8% transfusion 72%. An 8 showed be cut-off 6.2% at < 2.8% > = annually ( p 0.001). Multivariate analysis revealed patient (OR 6.4 octogenerians) ventilation time 14.3 24 h) 2.6) important risk factors mortality. Conclusion Our results show negative correlation this procedure. A per year seems reasonable successful significantly lower