Background/Objectives: Radical nephrectomy (RN) with inferior vena cava thrombectomy (IVCT) is indicated for the curative management of renal cell carcinoma (RCC) with tumor thrombus (TT). In the literature, any direct comparison of complications between RNs with or without IVCT is lacking. The objective of this study was to analyze and compare complications after RNs with or without IVCT. Methods: A retrospective evaluation of the complications recorded in RCC patients who underwent RN with (TT group,n= 44) or without (non-TT group,n= 44) IVCT between 2009 and 2021 was conducted. The non-TT group was identified via propensity-score matched-pair analysis. Postoperative complications up until discharge or postoperative day 30, whichever came first, were classified using the Clavien–Dindo classification (CDC). Complications were categorized into cardiovascular, pulmonary, bleeding, gastrointestinal, neurological/psychiatric, wound, urinary tract, dysglycemia, and other groups. Statistical analyses using descriptive statistics included the chi2and Mann–Whitney U tests. Results: All CDC-grade postoperative complications were more frequent in the TT than in the non-TT group regarding the number of patients affected (93% vs. 73%), as well as per patient (median: 3 vs. 1;p< 0.001). Complications in CDC grade ≥ 3 were rare and comparable between groups. Cardiovascular, gastrointestinal, neurological/psychiatric, and bleeding complications occurred significantly more often in the TT group. However, its small study population and retrospective character limit this study. Conclusions: Significantly more patients undergoing an RN-IVCT experience more frequent postoperative complications than patients with an RN but without IVCT. Surgeons performing the procedures should be experienced, and hospital staff should be trained in the early recognition and treatment of complications.
背景/目的：根治性肾切除术（RN）联合下腔静脉癌栓切除术（IVCT）是治疗伴有癌栓（TT）的肾细胞癌（RCC）的根治性手段。现有文献中缺乏对联合或不联合IVCT的RN术后并发症的直接比较。本研究旨在分析和比较联合或不联合IVCT的RN术后并发症情况。方法：本研究回顾性评估了2009年至2021年间接受RN联合IVCT（TT组，n=44）或不联合IVCT（非TT组，n=44）的RCC患者记录的并发症。非TT组通过倾向评分匹配分析确定。记录患者出院前或术后30天内（以先发生者为准）的术后并发症，并采用Clavien-Dindo分级（CDC）进行分类。并发症分为心血管、肺部、出血、胃肠道、神经/精神、伤口、泌尿系统、血糖异常及其他类别。使用描述性统计进行统计分析，包括卡方检验和Mann-Whitney U检验。结果：就发生并发症的患者数量（93% vs. 73%）以及每名患者的并发症数量（中位数：3 vs. 1；p < 0.001）而言，所有CDC分级的术后并发症在TT组均比非TT组更常见。CDC分级≥3级的并发症较为罕见，且两组间具有可比性。心血管、胃肠道、神经/精神以及出血并发症在TT组的发生率显著更高。然而，本研究样本量较小且为回顾性研究，存在局限性。结论：与仅接受RN而未行IVCT的患者相比，接受RN-IVCT的患者术后并发症发生率显著更高，且并发症更为频繁。实施此类手术的外科医生应具备丰富经验，医院工作人员应接受早期识别和处理并发症的培训。
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