Surgical and Oncologic Outcomes of Laparoscopic Versus Open Radical Nephrectomy with Venous Thrombectomy: A Propensity-Matched Retrospective Cohort Study

Background: To compare the surgical and oncologic outcomes between laparoscopic and open radical nephrectomy with venous thrombectomy (LRN-VT, ORN-VT) in patients with renal tumor and venous thrombus. Materials and Methods: We conducted a propensity-matched retrospective cohort study of 302 patients with renal tumor and venous thrombus from January 2014 to January 2021. We compared surgical outcomes and we used the Kalan-Meier method to assess the overall survival (OS), tumor-specific survival (TSS), metastasis-free survival (MFS) and local recurrence-free survival (LRFS). The Pearson chi-square test and Fisher exact test, Wilcoxon rank sum test, Cox proportional hazards regression model and log-rank test were used. Results: After 1:1 matching, 94 patients were identified in each group and baseline characteristics were comparable. The LRN-VT group had less operative time (median 292min vs 326min, P < 0.001), less blood loss (median 500 ml vs 1000 ml, P < 0.001), fewer packed red blood cells transfusion (median 800 ml vs 1200 ml. P < 0.001) and less fresh frozen plasma transfusion (median 400 ml vs 600 ml. P < 0.001). The ORN-VT group had higher complication rate (39.4% vs 21.3%. P = 0.007), higher Clavien grade (P = 0.005) and longer postoperative hospital stay (median 10d vs 8d, P < 0.001). The median time to local recurrence were 36mon after a median follow-up of 31mon in the LRN-VT group and 8mon (IQR 6-15 mon) after a median follow-up of 32mon in the ORN-VT group (P = 0.007). The hazard ratio of LRFS for the LRN-VT group was 0.18 (95% CI 0.05-0.62. P = 0.007). Conclusions: LRN-VT can result in favorable surgical outcomes and a better LRFS compared with ORN-VT.