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.
© 2024. The Author(s).