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The following is a summary of “Risk factors for renal insufficiency and survival implications after radical nephrectomy and thrombectomy in renal cell carcinoma with tumor thrombus: a systematic review,” published in the January 2025 issue of BMC Urology by Huang et al.
Renal cell carcinoma (RCC) with venous tumor thrombus (VTT) poses a significant global burden. Radical nephrectomy (RN) with thrombectomy is the gold standard treatment but may impair renal function.
Researchers conducted a retrospective study to evaluate the incidence, risk factors, and impact of renal insufficiency in patients with RCC undergoing RN with thrombectomy.
They systematically searched PubMed, Embase, Web of Science, Cochrane Library, and European Urology. About 11 articles matching PICOS were included. The study was registered with PROSPERO, CRD42024516596.
The results showed that 1,668 patients with RCC and VTT who underwent RN with thrombectomy were analyzed. Postoperative renal insufficiency ranged from 0.7% to 53.9%. Risk factors included baseline characteristics (male gender, tumor thrombus level), intraoperative factors (surgical method, inferior vena cava clamping time), and other factors (time development). Renal insufficiency was caused by circulation volume depletion, altered renal hemodynamics, and solitary kidney condition. Overall survival (OS) ranged from 2 to 98 months. A clear survival-renal function association was not established due to oncological risks. Management strategies like blood volume supply, diuretics, and renal replacement therapy should be applied.
Investigators found that the incidence of postoperative renal insufficiency was underestimated and that more risk factors should be explored. They recommended large cohort, multi-center, prospective studies to corroborate the results and provide high-grade clinical recommendations.
Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01664-9
