Comparison of Open and Robot Assisted Radical Nephrectomy With Level I and II Inferior Vena Cava Tumor Thrombus: The Mayo Clinic Experience

Rose, Kyle; Navaratnam, Anojan; Faraj, Kassem; Abdul-Muhsin, Haidar; Syal, Amit; Elias, Laila; Moss, Adyr; Eversman, William G.; Stone, William M.; Money, Samuel R.; Davila, Victor J.; Tyson, Mark D.; Castle, Erik P.

doi:10.1016/j.urology.2019.11.002

Cited by 23 publications

(24 citation statements)

References 22 publications

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“…Various distinct features of robotic platforms may be beneficial in tackling demanding surgical procedures, 3 which are usually handled with open surgery, such as the management of tumors involving large vessels. In fact, there have been some reports describing promising findings on RARN and inferior vena cava thrombectomy, 20,21 suggesting the usefulness of a robotic approach for this type of surgery by facilitating easier vessel reconstruction and minimizing caval manipulation. Furthermore, in the present series, one tumor accompanied by a renal vein thrombus was successfully resected using the ENDOWRIST robotic stapler.…”

Section: Discussionmentioning

confidence: 99%

Initial experience of robot‐assisted radical nephrectomy in Japan: Single institutional study of 12 cases

Motoyama

Kawakami

Sato

et al. 2021

Asian J Endoscop Surgery

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Introduction To evaluate the initial experience of robot‐assisted radical nephrectomy (RARN) in a single institution in Japan. Methods This study included a total of 12 patients with renal tumors who were not preoperatively regarded as optimal candidates for robot‐assisted partial nephrectomy (RAPN) and subsequently treated with RARN between April 2019 and June 2021 at our institution. Comprehensive perioperative outcomes in these patients were retrospectively analyzed. Results Of the 12 included patients, 10 and two were male and female, respectively, and the median age was 66 years. The median tumor diameter was 44 mm, and four, four and four patients were classified into cT1a, cT1b and cT3a, respectively. There was no patient requiring open conversion, and the median operative and console times were 167 and 79 minutes, respectively. The median estimated blood loss was 42 cc, and no patient required blood transfusion. During the perioperative period, no major complication corresponding to Clavien‐Dindo grade ≥3 occurred. Nine, two and one patient were pathologically diagnosed with clear cell carcinoma (CCC), non‐CCC and benign cyst, respectively, and there was no patient who developed recurrent diseases. Conclusions Considering complicated tumor characteristics not amenable to RAPN in this series, such as an intravenous tumor thrombus or previous history of open partial nephrectomy, perioperative outcomes of initial experience with RARN in Japan could be considered favorable. Collectively, these findings suggest that RARN may be a promising alternative to laparoscopic radical nephrectomy for patients with complicated renal tumors, contraindicated for RAPN.

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Section: Discussionmentioning

confidence: 99%

Initial experience of robot‐assisted radical nephrectomy in Japan: Single institutional study of 12 cases

Motoyama

Kawakami

Sato

et al. 2021

Asian J Endoscop Surgery

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“…With the development of robot-assisted surgical techniques in urological surgery, the safety and feasibility of robot-assisted IVC thrombectomy for selected patients have previously been demonstrated. For level I-II IVC tumor thrombus, the Mayo Clinic experience showed that [18], compared with open surgery, robotic surgery had a longer operative time (284 minutes compared with 242 minutes), lower estimated blood loss (450 ml compared with 1800 ml), shorter length of stay in hospital (3 days compared with 7 days), and a lower complication rate (17% compared with 43%) [8]. In a previously reported preliminary study, we showed that robot-assisted IVC thrombectomy had a shorter operative time (150 minutes compared with 230 minutes), a lower estimated blood loss (250 ml compared with 1000 ml), a shorter length of stay in hospital (5 days compared with 9 days), and lower complication rate (9.7% compared with 29%) when compared with the open approach [19].…”

Section: Discussionmentioning

confidence: 99%

Cumulative Sum Analysis of the Operator Learning Curve for Robot-Assisted Mayo Clinic Level I–IV Inferior Vena Cava Thrombectomy Associated with Renal Carcinoma: A Study of 120 Cases at a Single Center

Shen

Wang

et al. 2020

Med Sci Monit

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Departmental sources Background:This study aimed to use cumulative sum analysis of the operator learning curve for robot-assisted Mayo Clinic level I-IV inferior vena cava (IVC) thrombectomy associated with renal carcinoma, and describes the development of an optimized operative procedure at a single center. Material/Methods:A retrospective study included 120 patients with Mayo Clinic level I-IV IVC thrombus who underwent robotic surgery between 2013 and 2018. Points in the learning curve were identified using cumulative sum analysis, and their impact was assessed by multiple regression analysis. Perioperative indicators analyzed included operative time, estimated blood loss, early complications, and the 90-day progression rate. Results:Cumulative sum analysis identified three phases in the learning curve of robot-assisted IVC thrombectomy. The median operative time decreased from 265 min (range, 212-401 min) to 207 min (range, 146-276 min) (p=0.003), the median estimated blood loss decreased from 775 ml (range, 413-1500 ml) to 300 ml (range, 163-813 ml) (p=0.006), and the early complication rate decreased from 52.5% to 15.0% (p<0.001). Multivariate analysis showed that for an initial 40 cases and a further 80 cases, the learning phase, the affected side, the Mayo Clinic level, and the surgical method were independent factors that affected operative time, estimated blood loss, and the rate of early complications. Conclusions:Experience from an initial 40 cases and a further 80 cases of Mayo Clinic level I-IV IVC thrombectomy associated with renal carcinoma were found to provide acceptable surgical and clinical outcomes.

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“…Gu et al [30] also observed that robotic cohort had a comparable OS and TSS with open cohort in a propensity-matched cohort study after a median follow-up of 27 mon and 48 mon respectively. Rose et al [29] reported that there was no statistically significant difference in OS and recurrence-free survival between robotic procedure and open procedure. However, in our study we found that LRN-VT was associated with a lower risk of local recurrence and the median LRFS was much longer in the LRN-VT group than that in the ORN-VT group.…”

Section: Lrn-vt(n = 94) Orn-vt(n = 94) P Valuementioning

confidence: 99%

“…These findings supported that LRN-VT had greater advantages in surgical outcomes over ORN-VT. RALRN-VT has been clinically applied in several centers since its first report in 2011 [4,[26][27][28]. Kyle et al [29] compared the perioperative and oncologic outcomes of level I-II thrombus between RALRN-VT and ORN-VT and found that RALRN-VT produced shorter hospital stay, less transfusion and a lower complication rate with no statistically significant difference in OS. Gu et al [30] concluded that RALRN-VT can achieve more favorable perioperative outcomes and similar oncologic outcomes compared with ORN-VT.…”

Section: Lrn-vt(n = 94) Orn-vt(n = 94) P Valuementioning

confidence: 99%

Surgical and Oncologic Outcomes of Laparoscopic Versus Open Radical Nephrectomy with Venous Thrombectomy: A Propensity-Matched Retrospective Cohort Study

Zhang

Yan

et al. 2021

International Journal of Surgery Oncology

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Background: To compare the surgical and oncologic outcomes between laparoscopic and open radical nephrectomy with venous thrombectomy (LRN-VT, ORN-VT) in patients with renal tumor and venous thrombus. Materials and Methods:We conducted a propensity-matched retrospective cohort study of 302 patients with renal tumor and venous thrombus from January 2014 to January 2021. We compared surgical outcomes and we used the Kalan-Meier method to assess the overall survival (OS), tumor-specific survival (TSS), metastasis-free survival (MFS) and local recurrence-free survival (LRFS). The Pearson chi-square test and Fisher exact test, Wilcoxon rank sum test, Cox proportional hazards regression model and log-rank test were used.Results: After 1:1 matching, 94 patients were identified in each group and baseline characteristics were comparable. The LRN-VT group had less operative time (median 292min vs 326min, P < 0.001), less blood loss (median 500 ml vs 1000 ml, P < 0.001), fewer packed red blood cells transfusion (median 800 ml vs 1200 ml, P < 0.001) and less fresh frozen plasma transfusion (median 400 ml vs 600 ml, P < 0.001). The ORN-VT group had higher complication rate (39.4% vs 21.3%, P = 0.007), higher Clavien grade (P = 0.005) and longer postoperative hospital stay (median 10d vs 8d, P < 0.001). The median time to local recurrence were 36mon after a median follow-up of 31mon in the LRN-VT group and 8mon (IQR 6-15 mon) after a median follow-up of 32mon in the ORN-VT group (P = 0.007). The hazard ratio of LRFS for the LRN-VT group was 0.18 (95% CI 0.05-0.62, P = 0.007).Conclusions: LRN-VT can result in favorable surgical outcomes and a better LRFS compared with ORN-VT.

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Comparison of Open and Robot Assisted Radical Nephrectomy With Level I and II Inferior Vena Cava Tumor Thrombus: The Mayo Clinic Experience

Cited by 23 publications

References 22 publications

Initial experience of robot‐assisted radical nephrectomy in Japan: Single institutional study of 12 cases

Initial experience of robot‐assisted radical nephrectomy in Japan: Single institutional study of 12 cases

Cumulative Sum Analysis of the Operator Learning Curve for Robot-Assisted Mayo Clinic Level I–IV Inferior Vena Cava Thrombectomy Associated with Renal Carcinoma: A Study of 120 Cases at a Single Center

Surgical and Oncologic Outcomes of Laparoscopic Versus Open Radical Nephrectomy with Venous Thrombectomy: A Propensity-Matched Retrospective Cohort Study

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