{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:51:39Z","timestamp":1787241099700,"version":"build-2736575974"},"reference-count":36,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: For surgical candidates with metastatic renal cell carcinoma with a tumor thrombus (mRCC-TT), surgery is cytoreductive nephrectomy with tumor thrombectomy (CN-TT). This is carried out through an open (OCN-TT), laparoscopic (LCN-TT), or robotic (RCN-TT) approach. The purpose of this study was to compare survival outcomes to CN-TT by operative approach. Methods: This was a retrospective analysis of all patients with a diagnosis of mRCC-TT, who underwent CN-TT from a multi-institutional database from 1999\u20132024. Metastatic locations were qualified as either lung, bone, brain, liver, retroperitoneum, adrenal, paraaortic nodes, or other nodes. Progression was defined as radiographic evidence of recurrence or metastasis not seen on imaging prior to CN-TT. Progression locations were all metastatic locales previously noted plus the nephrectomy bed. Overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) were calculated. Comparisons were performed between OCN-TT, LCN-TT, and RCN-TT. Results: A total of 131 patients were included in the analysis (97 OCN-TT, 25 LCN-TT, and 9 RCN-TT). The TT level was not different (p-value &gt; 0.05) by approach (p-value &gt; 0.05). Preoperative tumor size, final pathologic tumor subtype, and postoperative tumor size were equivalent between the three surgical approaches (p-value &gt; 0.05). Rates of progression were equivalent as were all locations of disease progression in the study (p-value &gt; 0.05). Median OS was 1.6 years in OCN-TT, 1.5 years in LCN-TT, and 2.5 years in RCN-TT (p-value = 0.42). Median CSS was 2.1 years in OCN-TT, 3 years in LCN-TT, and 2.5 years in RCN-TT (p-value = 0.86). PFS was 0.8 years in OCN-TT, 1.2 years in LCN-TT, and 1.2 years in RNC-TT (p-value = 0.76). Conclusions: The operative approach does not affect survival outcomes for CN-TT. Surgeon comfort and patient preference should weigh heavily in operative decision making.<\/jats:p>","DOI":"10.3390\/cancers17213490","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T03:33:07Z","timestamp":1761881587000},"page":"3490","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Comparing Cytoreductive Nephrectomy with Tumor Thrombectomy Between Open, Laparoscopic, and Robotic Approaches"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2880-1857","authenticated-orcid":false,"given":"Maxwell","family":"Sandberg","sequence":"first","affiliation":[{"name":"Department of Urology, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0270-3618","authenticated-orcid":false,"given":"Gregory","family":"Russell","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Krol","sequence":"additional","affiliation":[{"name":"Department of Urology, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell","family":"Hayes","sequence":"additional","affiliation":[{"name":"Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa Bay, FL 33601, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randall","family":"Bissette","sequence":"additional","affiliation":[{"name":"Department of Urology, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reuben","family":"Ben David","sequence":"additional","affiliation":[{"name":"Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10031, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4698-6856","authenticated-orcid":false,"given":"Kartik","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Alabama Birmingham Medical Center, Birmingham, AL 35233, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brejjette","family":"Aljabi","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Alabama Birmingham Medical Center, Birmingham, AL 35233, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seok-Soon","family":"Byun","sequence":"additional","affiliation":[{"name":"Department of Urology, Seoul National University Bundang Medical Center, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar Rodriguez","family":"Faba","sequence":"additional","affiliation":[{"name":"Department of Urology, Puigvert Foundation, 08025 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricio Garcia","family":"Marchinena","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Italiano, Buenos Aires C1181ACH, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4800-6009","authenticated-orcid":false,"given":"Thiago","family":"Mourao","sequence":"additional","affiliation":[{"name":"Department of Urology, A.C. Camargo Cancer Institute, Sao Paulo 01509-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0269-4152","authenticated-orcid":false,"given":"Gaetano","family":"Ciancio","sequence":"additional","affiliation":[{"name":"Department of Urology and Transplant Surgery, University of Miami Miller School of Medicine, Miami, FL 33131, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles C.","family":"Peyton","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Alabama Birmingham Medical Center, Birmingham, AL 35233, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Zanotti","sequence":"additional","affiliation":[{"name":"Department of Urology, A.C. Camargo Cancer Institute, Sao Paulo 01509-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5723-1972","authenticated-orcid":false,"given":"Philippe E.","family":"Spiess","sequence":"additional","affiliation":[{"name":"Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa Bay, FL 33601, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Mehrazin","sequence":"additional","affiliation":[{"name":"Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10031, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9466-9925","authenticated-orcid":false,"given":"Soroush","family":"Rais-Bahrami","sequence":"additional","affiliation":[{"name":"Department of Urology, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA"},{"name":"Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC 27157, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8232-5092","authenticated-orcid":false,"given":"Diego","family":"Abreu","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Pasteur, Montevideo 11600, Uruguay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stenio de Cassio","family":"Zequi","sequence":"additional","affiliation":[{"name":"Department of Urology, A.C. Camargo Cancer Institute, Sao Paulo 01509-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro R.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Urology, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA"},{"name":"Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC 27157, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s11701-025-02424-z","article-title":"A comparison of open, laparoscopic, and robotic radical nephrectomy with tumor thrombectomy from the intercontinental collaboration on renal cell carcinoma","volume":"19","author":"Sandberg","year":"2025","journal-title":"J. Robot. 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