Association of an organ transplant-based approach with a dramatic reduction in postoperative complications following radical nephrectomy and tumor thrombectomy in renal cell carcinoma

Javier González, Jeffrey J. Gaynor, Juan I. Martínez-Salamanca, Umberto Capitanio, Derya Tilki, Joaquín A. Carballido, Venancio Chantada, Siamak Daneshmand, Christopher P. Evans, Claudia Gasch, Paolo Gontero, Axel Haferkamp, William C. Huang, Estefania Linares Espinós, Viraj A. Master, James M. McKiernan, Francesco Montorsi, Sascha Pahernik, Juan Palou, Raj S. PruthiOscar Rodriguez-Faba, Paul Russo, Douglas S. Scherr, Shahrokh F. Shariat, Martin Spahn, Carlo Terrone, Cesar Vera-Donoso, Richard Zigeuner, Markus Hohenfellner, John A. Libertino, Gaetano Ciancio

Research output: Contribution to journalArticlepeer-review


Objectives: Our aim was to determine whether using an organ transplant-based(TB) approach reduces postoperative complications(PCs) following radical nephrectomy(RN) and tumor thrombectomy(TT) in renal cell carcinoma(RCC) patients with level II-IV thrombi. Methods: A total of 390(292 non-TB/98 TB) IRCC-VT Consortium patients who received no preoperative embolization/IVC filter were included. Stepwise linear/logistic regression analyses were performed to determine significant multivariable predictors of intraoperative estimated blood loss(IEBL), number blood transfusions received, and overall/major PC development within 30days following surgery. Propensity to receive the TB approach was controlled. Results: The TB approach was clearly superior in limiting IEBL, blood transfusions, and PC development, even after controlling for other significant prognosticators/propensity score(P < .000001 in each case). Median IEBL for non-TB/TB approaches was 1000 cc/300 cc and 1500 cc/500 cc for tumor thrombus Level II-III patients, respectively, with no notable differences for Level IV patients(2000 cc each). In comparing PC outcomes between non-TB/TB patients with a non-Right-Atrium Cranial Limit, the observed percentage developing a: i) PC was 65.8%(133/202) vs. 4.3%(3/69) for ECOG Performance Status(ECOG-PS) 0–1, and 84.8%(28/33) vs. 25.0%(4/16) for ECOG-PS 2–4, and ii) major PC was 16.8%(34/202) vs. 1.4%(1/69) for ECOG-PS 0–1, and 27.3%(9/33) vs. 12.5%(2/16) for ECOG-PS 2–4. Major study limitation was the fact that all TB patients were treated by a single, experienced, high volume surgeon from one center (non-TB patients were treated by various surgeons at 13 other centers). Conclusions: Despite this major study limitation, the observed dramatic differences in PC outcomes suggest that the TB approach offers a major breakthrough in limiting operative morbidity in RCC patients receiving RN and TT.

Original languageEnglish
Pages (from-to)1983-1992
Number of pages10
JournalEuropean Journal of Surgical Oncology
Issue number10
Publication statusPublished - Oct 2019


  • Inferior vena cava
  • Postoperative complications
  • Renal cell carcinoma
  • Surgical technique
  • Tumor thrombus

ASJC Scopus subject areas

  • Surgery
  • Oncology


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