Comparing Cytoreductive Nephrectomy with Tumor Thrombectomy Between Open, Laparoscopic, and Robotic Approaches

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Metastatic renal cell carcinoma with a tumor thrombus (mRCC-TT) requires cytoreductive nephrectomy with tumor thrombectomy (CN-TT).
• Surgical approaches include open (OCN-TT), laparoscopic (LCN-TT), and robotic (RCN-TT).

Purpose of the Study:

• To compare survival outcomes of CN-TT based on the operative approach.

Main Methods:

• Retrospective analysis of 131 mRCC-TT patients undergoing CN-TT (1999-2024).
• Comparison of overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) between OCN-TT, LCN-TT, and RCN-TT.
• Analysis included metastatic locations, progression rates, and locations.

Main Results:

• No significant differences in tumor thrombus level, tumor size, or subtype across approaches.
• Equivalent rates and locations of disease progression between OCN-TT, LCN-TT, and RCN-TT.
• Median OS: 1.6 (OCN-TT), 1.5 (LCN-TT), 2.5 (RCN-TT) years. Median CSS: 2.1 (OCN-TT), 3 (LCN-TT), 2.5 (RCN-TT) years. Median PFS: 0.8 (OCN-TT), 1.2 (LCN-TT), 1.2 (RCN-TT) years. No statistically significant differences in survival outcomes were observed (p > 0.05).

Conclusions:

• The operative approach for CN-TT in mRCC-TT does not influence survival outcomes.
• Surgeon expertise and patient preference are key factors in selecting the surgical method.