Maxwell Sandberg, MD, on operative approach and survival outcomes with CN-TT

Data presented at the 2025 Society of Urology Oncology Annual Meeting in Phoenix, Arizona suggested that operative approach did not appear to have any impact on survival outcomes among patients undergoing cytoreductive radical nephrectomy with tumor thrombectomy (CN-TT).¹

In an interview with Urology Times®, presenting author Maxwell L. Sandberg, MD, outlined the key findings and implications of this study for surgeon decision-making. Sandberg is a PGY-4 urology resident at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

In total, the study retrospectively assessed 131 patients with metastatic renal cell carcinoma with a tumor thrombus (mRCC-TT) who underwent CN-TT via an open (OCN-TT) approach (n = 97), laparoscopic (LCN-TT) approach (n = 25), or a robotic (RRN-TT) approach (n = 9). Data were collected from the Intercontinental Collaboration on Renal Cell Carcinoma (ICORCC) database.

Overall, the results showed no significant difference between the 3 approaches in terms of overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS).

Specifically, the median OS was 1.6 years in the OCN-TT arm, 1.5 years in LCN-TT arm, and 2.5 years in RCN-TT arm (P = .42). The median CSS was 2.1 years in OCN-TT arm, 3 years in LCN-TT arm, and 2.5 years in RCN-TT arm (P = .86). Similarly, median PFS was 0.8 years in OCN-TT, 1.2 years in LCN-TT, and 1.2 years in RNC-TT (P = .76).

“[The takeaway] is [that] minimally invasive approaches do not compromise cancer survival, recurrence, or progression. [The] robotic approach, in particular, for levels 1 through 3 tumor thrombi, is safe and feasible to perform.” Sandberg concluded. “That being said, more traditional approaches like open and laparoscopic also do not compromise survival outcomes, so it's really whatever the surgeon is most comfortable with, along with what the patient may desire, and then patient factors that might be outside of the surgeon's control, [such as] BMI or comorbidities.”

REFERENCE

1. Sandberg M, Russell G, Bissette R, et al. COMPARING OPEN, LAPAROSCOPIC, AND ROBOTIC CYTOREDUCTIVE RADICAL NEPHRECTOMY WITH TUMOR THROMBECTOMY. Presented at: Society of Urologic Oncology Annual Meeting; December 2-5, 2025; Phoenix, Arizona. Abstract 18. https://suo-abstracts.secure-platform.com/a/gallery/rounds/24/details/4579