A cirurgia robótica usada na trombectomia da veia cava inferior (VCI) tem sido realizada com segurança, mesmo em casos de trombos nível III e IV.Apresentamos um caso de tumor do rim com trombo na veia cava de nível III submetido com sucesso a nefrectomia radical direita com trombectomia da veia cava inferior e linfadenectomia retroperitoneal por via laparoscópica assistida por robot. Trata-se de uma senhora de 73 anos com um tumor do rim direito com cerca de 6 cm com sinais de extensão extrarenal e presença de um trombo da veia renal direita e veia cava inferior intrahepática, com suspeita de envolvimento de gânglios retroperitoneais em tomografia computorizada. O tempo operatório foi de 340 minutos e as perdas estimadas em 300 mL. Não houve intercorrências no pós-operatório.A trombectomia tumoral da VCI mantém-se uma cirurgia desafiante e de alto risco. No entanto, com experiência e técnica cirúrgica meticulosa com apoio do robot, o procedimento pode ser exequível em casos devidamente selecionados.

Objectives: The aim of this study was to com-pare the risk of International Society of Urological Pathology (ISUP) score upgrading between magnetic resonance imaging targeted fusion biopsy (MRI-TB) and tran-srectal ultrasound-guided biopsy (TRUS-B) in the final radical prostatectomy (RP) specimen pathological report.Materials and methods: This retrospective single center study included 51 patients with prostate cancer (PCa) diagnosed with MRI-TB and 83 patients diagnosed with TRUS-B between October/2019 and July/2021. We compared the rates of ISUP score upgrading between both groups after robotic-assisted radi-cal prostatectomy (RARP) and the specific transition of each ISUP score based on biopsy modality. The rate of ISUP score concordance and downgrading were also assessed. To define the intra and interobserver concordance for each ISUP score in biopsy and RP specimen for each biopsy modality, the Cohen’s Kappa coefficient was calculated. ISUP scores and biopsy modal-ity were selected for multivariate analysis and a logistic regres-sion model was built to provide independent risk factors of ISUP score upgrading.Results: The difference of the rate of upgrading between MRI-TB group and TRUS-B group was statistically significant (p = 0.007) with 42.2% of patients of TRUS-B group experiencing an upgrade in their ISUP score while only 19.6% in MRI-TB group. Concordance and downgrading rates did not statistically differ between the two groups. Strength of concordance using Cohen’s Kappa coefficient was fair in both groups but higher in MRI-TB group (TRUS-B group k = 0.230; p < 0.001; concordance: 47%vs. MRI/TB group k = 0.438; p < 0.001; concordance: 62.7%). Biopsy modality and ISUP 1 on biopsy were independent predic-tors of ISUP upgrading after RP.Conclusions: MRI-TB is highly accurate with lower risk of PCa upgrading after RP than TRUS-B. Patients with ISUP 1 on biopsy have greater susceptibility to upgrading their ISUP score.

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