Predicting Complications After Radical Nephrectomy With Venous Tumor Thrombectomy and Various IVC Reconstruction...

To develop an individualized risk calculator for major complications after radical nephrectomy and tumor thrombectomy performed for renal cell carcinoma (RCC).

We assessed patients who underwent nephrectomy and venous tumor thrombectomy for RCC from 2000 to 2021. The primary outcome was experiencing a high-grade complication within 30 days of surgery. A LASSO logistic regression model screened variables to identify predictors of major complications, which were subsequently used to create a nomogram.

Among 617 patients, high-grade complications occurred in 9.2% of patients and increased with the increasing cephalad extent of VTT: 4.7% (renal vein only), 11.6% (IVC), and 30.8% (supradiaphragmatic), P <.001. The 30-day mortality rate was <1%. In patients with thrombus extending into the IVC or higher, there was no difference in high-grade complication rates with primary closure, patch venoplasty, tube graft replacement, or IVC ligation. The variables with the highest discriminative ability to predict major complications were: thrombus level, concurrent surgery, and ECOG performance status. These variables were used to develop a nomogram that had an AUC = 0.69 in the development cohort (70%) and AUC = 0.77 in the validation cohort (30%).

Thrombus level, anticipated concurrent surgery, and patient performance status, though not IVC reconstruction technique, were associated with major complications in the first 30 days after surgery. Our internally validated, parsimonious nomogram predicting major complications after nephrectomy for RCC with VTT may aid surgeons in patient selection and individualize preoperative counseling.