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Comparative Study
. 2025 Jul;136(1):143-149.
doi: 10.1111/bju.16739. Epub 2025 Apr 14.

Investigation of whether renal tumours with caval thrombi induce particular risks: a multicentre study (UroCCR-174 CAVORISK)

Adrien Panis  1 , Thibaut Waeckel  2 , Karim Bensalah  3 , Pierre Bigot  4 , Louis Surlemont  5 , Franck Bruyere  6 , Nicolas Doumerc  7 , Fayek Taha  8 , Jonathan Olivier  9 , Jean-Jacques Patard  10 , Alexis Fontenil  11 , Nicolas Branger  12 , Romain Boissier  13 , Pierre Merlin  14 , Maxime Vallee  15 , Clément Sarrazin  16 , Norbert De Brek  17 , Benjamin Rouget  18 , Jean-Christophe Bernhard  19 , Alexandre Ingels  20
Affiliations
Comparative Study

Investigation of whether renal tumours with caval thrombi induce particular risks: a multicentre study (UroCCR-174 CAVORISK)

Adrien Panis et al. BJU Int. 2025 Jul.

Abstract

Objective: To compare outcomes of nephrectomy for left-sided (n = 70) vs right-sided (n = 118) renal tumours with caval thrombi.

Methods: In this retrospective analysis (June 2008-February 2023), we evaluated peri-operative variables, 30-day complications, estimated glomerular filtration rate (eGFR), and survival rates.

Results: Patients in the left-sided renal tumour group experienced significantly longer operating times (240 vs 193 min; P < 0.001), greater blood loss (1700 vs 1000 mL, P = 0.042), and more complications (53% vs 35%, P = 0.015). Postoperative renal function was worse in the left-sided vs the right-sided renal tumour group, with lower immediate postoperative eGFR (P = 0.035) and a higher dialysis rate (17% vs 6.8%, P = 0.026). However, overall survival and recurrence-free survival were similar (P = 0.8 and P = 0.43, respectively).

Conclusions: Left-sided renal tumours with caval thrombi present a higher risk of complications and acute kidney injury requiring dialysis, potentially due to left renal vein ischaemia during surgery and anatomical proximity to the superior mesenteric artery. Thorough preoperative planning and limited clamping time are essential.

Keywords: haemodialysis; inferior vena cava thrombi; kidney cancer; laterality; locally advanced; outcomes.

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