Background/Objectives:For surgical candidates with metastatic renal cell carcinoma with a tumor thrombus (mRCC-TT), surgery is cytoreductive nephrectomy with tumor thrombectomy (CN-TT). This is carried out through an open (OCN-TT), laparoscopic (LCN-TT), or robotic (RCN-TT) approach. The purpose of this study was to compare survival outcomes to CN-TT by operative approach.Methods: This was a retrospective analysis of all patients with a diagnosis of mRCC-TT, who underwent CN-TT from a multi-institutional database from 1999–2024. Metastatic locations were qualified as either lung, bone, brain, liver, retroperitoneum, adrenal, paraaortic nodes, or other nodes. Progression was defined as radiographic evidence of recurrence or metastasis not seen on imaging prior to CN-TT. Progression locations were all metastatic locales previously noted plus the nephrectomy bed. Overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) were calculated. Comparisons were performed between OCN-TT, LCN-TT, and RCN-TT.Results: A total of 131 patients were included in the analysis (97 OCN-TT, 25 LCN-TT, and 9 RCN-TT). The TT level was not different (p-value > 0.05) by approach (p-value > 0.05). Preoperative tumor size, final pathologic tumor subtype, and postoperative tumor size were equivalent between the three surgical approaches (p-value > 0.05). Rates of progression were equivalent as were all locations of disease progression in the study (p-value > 0.05). Median OS was 1.6 years in OCN-TT, 1.5 years in LCN-TT, and 2.5 years in RCN-TT (p-value = 0.42). Median CSS was 2.1 years in OCN-TT, 3 years in LCN-TT, and 2.5 years in RCN-TT (p-value = 0.86). PFS was 0.8 years in OCN-TT, 1.2 years in LCN-TT, and 1.2 years in RNC-TT (p-value = 0.76).Conclusions: The operative approach does not affect survival outcomes for CN-TT. Surgeon comfort and patient preference should weigh heavily in operative decision making.
背景/目的：对于伴有瘤栓的转移性肾细胞癌（mRCC-TT）手术候选者，手术方式为减瘤性肾切除术联合瘤栓切除术（CN-TT）。该手术可通过开放（OCN-TT）、腹腔镜（LCN-TT）或机器人（RCN-TT）入路进行。本研究旨在比较不同手术入路CN-TT的生存结局。 方法：本研究对1999年至2024年间来自多机构数据库中所有诊断为mRCC-TT并接受CN-TT的患者进行了回顾性分析。转移部位限定为肺、骨、脑、肝、腹膜后、肾上腺、主动脉旁淋巴结或其他淋巴结。进展定义为CN-TT前影像学检查未发现的复发或转移的影像学证据。进展部位包括所有先前注明的转移部位以及肾切除床。计算了总生存期（OS）、癌症特异性生存期（CSS）和无进展生存期（PFS）。对OCN-TT、LCN-TT和RCN-TT进行了比较。 结果：共有131例患者纳入分析（97例OCN-TT，25例LCN-TT，9例RCN-TT）。不同手术入路间的瘤栓水平无差异（p值>0.05）。三种手术入路间的术前肿瘤大小、最终病理肿瘤亚型和术后肿瘤大小均相当（p值>0.05）。研究中的疾病进展率以及所有进展部位均无差异（p值>0.05）。OCN-TT组的中位OS为1.6年，LCN-TT组为1.5年，RCN-TT组为2.5年（p值=0.42）。OCN-TT组的中位CSS为2.1年，LCN-TT组为3年，RCN-TT组为2.5年（p值=0.86）。OCN-TT组的PFS为0.8年，LCN-TT组为1.2年，RCN-TT组为1.2年（p值=0.76）。 结论：手术入路不影响CN-TT的生存结局。外科医生的熟练程度和患者偏好应在手术决策中予以重点考虑。
肿瘤(癌症)患者之家