Background and Objectives: Retroperitoneal tumors with involvement of the inferior vena cava (IVC) often require resection of the IVC to achieve complete tumor removal. This study evaluates the safety and efficacy of IVC ligation without caval reconstruction.Methods: A retrospective chart review of patients who underwent IVC ligation (IVC-Ligation) and IVC resection with reconstruction (IVC-Reconstruction) at our institution between May 2004 and April 2021 was performed. Outcomes from the two surgical techniques were compared via univariate analysis using the Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables.Results: Forty-nine IVC-Ligation and six IVC-Reconstruction surgeries were identified. There were no differences in baseline demographics, tumor characteristics, complication rates, postoperative morbidity, or overall 5-year survival between groups. IVC-Reconstruction patients were more likely to require intensive care unit admission (83% vs. 33%; p = 0.0257) and the IVC-Ligation cohort had a tendency to present with nondebilitating postoperative lymphedema (35% vs. 0%; p = 0.1615), which resolved for most patients.Conclusions: IVC-Ligation is a viable surgical option for select patients presenting with retroperitoneal tumors with IVC involvement and provides acceptable shortand medium-term outcomes.
Background
Black patients face disparities in cancer outcomes. Additionally, Black patients are more likely to be undertreated and underrepresented in clinical trials. The recent recommendation to remove race from the estimated glomerular filtration rate (eGFR) results in lower eGFR values for Black patients. The ramifications of this decision, both intended and unintended, are still being elucidated in the medical community. Here, the authors analyze the removal of race from eGFR for Black patients with cancer, specifically with respect to clinical trial eligibility.
Methods
In a cohort of self‐identified Black patients who underwent nephrectomy at a tertiary referral center from 2009 to 2021 (n = 459), eGFR was calculated with and without race in commonly used equations (Chronic Kidney Disease Epidemiology Collaboration [CKD‐EPI] and Modification of Diet in Renal Disease [MDRD]). The distribution of patients and changes within chronic kidney disease stages with different equations was considered. Theoretical exclusion at commonly observed clinical trial eGFR points was then simulated on the basis of the utilization of the race coefficient.
Results
The median eGFR from CKD‐EPI was significantly higher with race (76 ml/min/1.73 m2) than without race (66 ml/min/1.73 m2; p < .0001). The median eGFR from MDRD was significantly higher with race (71.0 ml/min/1.73 m2) than without race (58 ml/min/1.73 m2; p < .0001). Observing results in the context of common clinical trial cutoff points, the authors found that 13%–22%, 6%–12%, and 2%–3% more Black patients would fall under common clinical trial cutoffs of 60, 45, and 30 ml/min, respectively, depending on the equation used. A subanalysis of stage III–IV patients only was similar.
Conclusions
Race‐free renal function equations may inadvertently result in increased exclusion of Black patients from clinical trials. This is especially concerning because of the underrepresentation and undertreatment that Black patients already experience.
Plain Language Summary
Black patients experience worse oncologic outcomes and are underrepresented in clinical trials.
Kidney function, as estimated by glomerular filtration rate equations, is a factor in who can and cannot be in a clinical trial.
Race is a variable in some of these equations.
For Black patients, removing race from these equations leads to the calculation of lower kidney function.
Lower estimated kidney function may result in more black patients being excluded from clinical trials.
The inclusion of all races in clinical trials is important for offering best care to everyone and for making results from clinical trials applicable to everyone.
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