Robot-assisted Cavectomy Versus Thrombectomy for Level II Inferior Vena Cava Thrombus: Decision-making Scheme and Multi-institutional Analysis

Shi, Taoping; Huang, Qingbo; Liu, Kan; Du, Songliang; Yang, Fan; Yang, Luojia; Peng, Cheng; Shen, Dan; Wang, Zhongxin; Gao, Yu; Gu, Liangyou; Niu, Shaoxi; Ai, Qing; Li, Hongzhao; Liu, Fengyong; Li, Qiuyang; Wang, Haiyi; Guo, Aitao; Fu, Bin; Yang, Xinggang; Zhang, Xuepei; Wang, Delin; Wang, Dongwen; Guo, Hongqian; Li, Hengping; Olivero, Alberto; Fam, Xeng Inn; Ma, Xin; Wang, Qianqian

doi:10.1016/j.eururo.2020.03.020

Cited by 25 publications

(13 citation statements)

References 30 publications

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“…The collateral circulation of the right kidney was not well established. Therefore, this kind of operation was easy to lead to renal insufficiency [ 20 ]. Postoperative edema of both lower limbs (Clavien grade II complication) occurred.…”

Section: Discussionmentioning

confidence: 99%

Inferior vena cava interruption in renal cell carcinoma with tumor thrombus: surgical strategy and perioperative results

et al. 2021

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Background To analyze the influence of inferior vena cava (IVC) interruption for perioperative and oncological results in patients with renal cell carcinoma and tumor thrombus and summarize the surgical strategies of IVC interruption for different situations. Methods We retrospectively analyzed the clinical and pathological data of 103 patients in our center. Patients were divided into two groups with 32 cases (31.1%) underwent IVC interruption (Group 1) while 71 cases (68.9%) did not. For comparison of continuous variables, the Mann–Whitney U test was used. For comparison of categorical variables, Chi-square tests were used. A propensity score based matching method was used to eliminate possible bias. Kaplan–Meier plots were performed to evaluate the influence of IVC interruption on overall survival and cancer specific survival. All the statistical analyses were performed using SPSS 24. A P value < 0.05 was considered statistically significant. Results Among the 32 patients who underwent IVC interruption, the median age was 61 years and the median tumor size was 7.7 cm. There were 28 males and 23 tumors were on the right side. We successfully matched 29 patients who underwent IVC interruption to 29 patients without this procedure in 1:1 ratio. No significant differences existed in baseline characteristics between the groups. The comparison of perioperative data showed that patients who underwent IVC interruption had significantly longer median postoperative hospital stays (13 vs 9 days, P = 0.022) and a higher overall postoperative complication rate (79.3 vs 51.7%, P = 0.027). According to the side and shape of tumor thrombus, it could be divided into four categories. There were 15 cases (46.9%) with right filled-type tumor thrombus (RFTT), 8 cases (25.0%) with right non-filled-type tumor thrombus (RNFTT), 1 case (3.1%) with left filled-type tumor thrombus (LFTT) and 8 cases (25.0%) with left non-filled-type tumor thrombus (LNFTT). According to different categories, different surgical procedures were adopted. Conclusions IVC interruption will increase the incidence of overall postoperative complications, but not the risk of major postoperative complications. Tumor thrombus should be divided into four categories, and different sides and shapes of renal tumor thrombus need different operative procedure of IVC interruption.

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Section: Discussionmentioning

confidence: 99%

Inferior vena cava interruption in renal cell carcinoma with tumor thrombus: surgical strategy and perioperative results

et al. 2021

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“…For patients with tumor thrombus invading IVC, Shi et al showed the feasibility of robot-assisted cavectomy and compared 30 patients undergoing robot-assisted cavectomy with 60 patients undergoing robot-assisted thrombectomy (cavotomy). 46 They found significantly longer operative time, higher estimated blood loss and higher perioperative complications in the cavectomy group.…”

Section: Resultsmentioning

confidence: 93%

A Decade of Robotic-Assisted Radical Nephrectomy with Inferior Vena Cava Thrombectomy: A Systematic Review and Meta-Analysis of Perioperative Outcomes

Garg¹,

Psutka

Hakimi

et al. 2022

Journal of Urology

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Purpose:Open radical nephrectomy with inferior vena cava thrombectomy (O-CT) is standard management for renal cell carcinoma with inferior vena cava thrombus. First reported a decade ago, robotic-assisted radical nephrectomy with inferior vena cava thrombectomy (R-CT) is a minimally invasive option for this disease. We aimed to perform a systematic review to assess the safety and feasibility of R-CT in terms of perioperative outcomes and compare the outcomes between R-CT and O-CT.Materials and Methods:The PubMed®, Scopus®, Cochrane Central Register of Controlled Trials and Web of ScienceTM databases were searched using the free-text and MeSH terms “renal cell carcinoma,” “inferior vena cava,” “thrombosis” or “thrombus,” “robot” and “thrombectomy.” Studies reporting perioperative outcomes of R-CT and studies comparing R-CT with O-CT were included. The review was done in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.Results:The search retrieved 28 articles describing R-CT, including 7 comparative studies. This systematic review included 1,375 patients, out of which 329 patients were in single-arm studies and 1,046 patients were in comparative studies. Of the 329 patients who underwent R-CT, 14.7% were level I, 60.9% level II, 20.4% level III and 2.5% level IV thrombus. Operative time ranged from 150 to 530 minutes; blood transfusion was administered in 38.2% (126). The overall complication rate was 30.3% (99). R-CT, in comparison to O-CT, was associated with a lower blood transfusion rate (18.4% vs 64.3%, p=0.002) and a lower complication rate (14.5% vs 36.7%, p=0.005). Major complication and 30-day mortality rates were similar in both groups.Conclusions:R-CT has acceptable perioperative outcomes in carefully selected patients. Compared with O-CT, R-CT is associated with a lower blood transfusion rate and fewer overall complications. In experienced hands with carefully selected patients, R-CT is feasible and safe, with acceptable outcomes; however, selection bias limits definitive inference of these results, and optimal patient selection criteria remain to be described.

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“… 24 Due to potential life threatening complications and the extensive surgical field needed for complex operations like nephrectomy with cavotomy, the standard for these operations is still an open approach, as indicated by the lack of comparative studies concerning this subject. 25 However, some groups have reported cases of combined robotic multivisceral resections like kidney and colorectal surgery for synchronous tumors or kidney and pancreatic surgery for oligometastatic kidney cancer with a synchronous pancreatic metastasis with satisfactory results. 26 , 27 Even though the sample size therefore is still small, this indicates that even extended multivisceral resections could be safely performed in a robotic manner.…”

Section: Discussionmentioning

confidence: 99%

Combined Open Prostatectomy and Kidney Surgery: Feasibility and 12-Month Outcome

Rath¹,

Jokisch²,

Schulz³

et al. 2021

RRU

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Robot-assisted Cavectomy Versus Thrombectomy for Level II Inferior Vena Cava Thrombus: Decision-making Scheme and Multi-institutional Analysis

Cited by 25 publications

References 30 publications

Inferior vena cava interruption in renal cell carcinoma with tumor thrombus: surgical strategy and perioperative results

Inferior vena cava interruption in renal cell carcinoma with tumor thrombus: surgical strategy and perioperative results

A Decade of Robotic-Assisted Radical Nephrectomy with Inferior Vena Cava Thrombectomy: A Systematic Review and Meta-Analysis of Perioperative Outcomes

Combined Open Prostatectomy and Kidney Surgery: Feasibility and 12-Month Outcome

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