Introduction. Venous invasion and tumor thrombus formation are rare, but life-threatening complications of renal cell carcinoma (RCC), especially in combination with metastases, are considered significant adverse prognostic factors. Aim. To systematize the existing knowledge and summarize the clinical experience of surgical treatment (open and robot-assisted surgery) of RCC with inferior vena cava (IVC) tumor thrombus. Materials and methods. A literature search in the period 2000-2022 was performed in core databases MEDLINE, Scopus, Clinicaltrials.gov, Google Scholar and Web of Science. The PICO framework (Population-Intervention-Comparison-Outcome) was used to develop a literature search strategy. The following keywords were used to search databases: «renal cell carcinoma», «venous invasion», «inferior vena cava tumor thrombus», «surgical treatment», «robot-assisted», «clinical outcomes». Results. A total of 65 publications were identified. Various classifications of tumor thrombus level are considered, their inferiority and superiority in terms of selecting optimal surgical treatment, both open or robot-assisted surgeries, are discussed. Independent predictors of severe perioperative complications are determined. Optimal surgical treatment of RCC with tumor thrombus is highlighted. Functional and oncological outcomes of patients with RCC with IVC tumor thrombus, who underwent open surgical intervention and robot-assisted ones, are presented. Conclusion. Open surgery in patients with RCC and IVC tumor thrombus above the hepatic veins is associated with prolonged surgery duration, higher intraoperative blood loss, and prolonged in-hospital stay. Prolonged in-hospital stay, the need for blood transfusion, metastasis, sarcomatoid differentiation, and Clavien-Dindo grade 3-5 postoperative complications are predictors of poor outcomes.
Introduction. Bladder cancer is the 10th most common cancer worldwide. Radical cystectomy remains the gold standard for muscle invasive bladder cancer. The active use of robot-assisted cystectomy for treating patients with bladder cancer allows considering it as an alternative surgical option. The review is aimed at collecting and systematizing the evidence base for intracorporeal robot-assisted cystectomy. Materials and methods. MEDLINE, Scopus, Clinicaltrials.gov, Google Scholar, and Web of Science databases were used with the PICO (Patient-InterventionComparison-Outcome) search strategy to identify research articles published between 2000 and 2022. The following keywords were used to search the medical literature: «robot-assisted cystectomy», «RARC», «orthotopic neobladder», «intracorporeal RARC», «extracorporeal RARC», «bladder cancer», «functional outcomes», and «clinical outcomes». The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist. Exclusion criteria: abstracts, review articles, editor's notes and comments, book chapters; experimental and laboratory studies on animals or cadavers. Results and disscussion. A total of 475 original articles were retrieved from the databases. Of them, 71 original articles were included in the analysis. The benefits and advantages of intracorporeal RARC at the intraoperative and postoperative period in comparison with RCE and extracorporeal RARC were reported. Functional and oncological outcomes following intracorporeal RARC are also comparable with RCE and extracorporeal RARC, suggesting the effectiveness and safety of the new surgical technology for treating patients with bladder cancer. Conclusions. The last decade has been marked with an active transition from traditional surgical techniques to robot-assisted surgery, enabling the precise performance, minimal trauma, and minimal intraoperative blood loss.
In recent years, the approach to the treatment of advanced renal cell carcinoma (RCC) has undergone significant changes. The introduction of targeted drugs in the systemic therapy of RCC in the 2000s began with tyrosine kinase inhibitors that replaced cytokines and had a revolutionary effect. Then the therapeutic arsenal was expanded with the introduction of doublets consisting of a combination of immune checkpoint inhibitors or immune checkpoint inhibitors and tyrosine kinase inhibitors. Tyrosine kinase inhibitors continue to represent an effective treatment option for metastatic RCC (mRCC), maintaining their position as first-line therapy in patients with a favorable prognosis. According to the CheckMate study, targeted therapy is highly effective, and the incidence of complications is generally lower than with nivolumab/ipilimumab combination therapy. Unlike dual immunotherapy, sunitinib does not expose patients with a favorable prognosis to undue risk of adverse events, while leaving more options for subsequent lines of therapy, and it's also often more cost-effective. The presented clinical observation is an example of successful monotherapy with sunitinib in a previously untreated mRCC patient with a favorable prognosis. This case is of particular interest due to the lesion of a single kidney and the patient's polymorbidity. Effective targeted therapy in the postoperative period had a positive effect on the quality and life expectancy.
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