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. 2024 Nov 29;43(1):1.
doi: 10.1007/s00345-024-05360-z.

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

Thomas Martin #  1 , Johannes Huber #  1 , Rainer Koch  1 , Marius Butea-Bocu  1 , Lennard Haak  1 , Luka Flegar  1 , Matthias Giese  1 , Fabian Kormann  1 , Cem Aksoy  1 , Aristeidis Zacharis  1 , Christer Groeben  2   3
Affiliations

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

Thomas Martin et al. World J Urol. .

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: We identified all cases with RCC, nephrectomy, and IVC procedures in the Federal Statistical Office billing database (2006-2020). We defined annual hospital caseload categories as low (< 4 cases), medium (4-9 cases) and high (> 9 cases) volume. Logistic multivariate models identified mortality-related factors. In addition, we analyzed data on tumor stage distribution from German cancer registries.

Results: We recorded 3,700 nephrectomies with IVC-tumor resection with stable annual case number of 247 mean. This correlated with a stable incidence of T3b/c RCC. Patient age was 66 ± 14 years. Of all cases, 56% occurred in low, 30% in medium, and 14% in high volume clinics without a significant trend towards centralization. The overall in-hospital mortality rate was 5.8% and the transfusion rate 72%. An annual caseload of 8 showed to be a significant cut-off for mortality with 6.2% at < 8 cases and 2.8% for > = 8 cases annually (p < 0.001). Multivariate analysis revealed patient age (OR 6.4 for octogenerians) ventilation time (OR 14.3 for > 24 h) and hospital caseload (OR 2.6) as the most important risk factors for in-hospital mortality.

Conclusion: Our results show a negative correlation of annual caseload and mortality for this procedure. A minimum number of 8 procedures per year seems reasonable for the successful management of IVC tumor thrombus with significantly lower mortality.

Keywords: Health services research; Hospital caseload; Mortality; Renal cell carcinoma; Tumor thrombus.

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Conflict of interest statement

Declarations. Ethical approval: This study was conducted in accordance with the Declaration of Helsinki in its latest version. This article does not contain any studies with animals performed by any of the authors. Analyzed data were completely anonymized and derived from established databases with rigorous data protection measures. Hence, informed consent was not required. We followed the “Reporting of studies Conducted using Observational Routinely collected health Data” and the “Consolidated Standards of Reporting Trials (CONSORT) 2010” statement. Competing interests: Dr. Huber reports personal fees from Amgen and Janssen, grants and non-financial support from Intuitive Surgical and Takeda, outside the submitted work. All authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Development of Caseload distribution among caseload categories per hospital and year for surgical management of RCCTT in Germany
Fig. 2
Fig. 2
Relation of annual caseload per hospital and mortality for surgical management of RCCTT in Germany
See this image and copyright information in PMC

References

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