Robot-assisted Level III-IV Inferior Vena Cava Thrombectomy: Initial Series with Step-by-step Procedures and 1-yr Outcomes

Wang, Qianqian; Huang, Qingbo; Liu, Kan; Yang, Fan; Peng, Cheng; Gu, Liangyou; Shi, Taoping; Zhang, Peng; Chen, Wenzheng; Du, Songliang; Niu, Shaoxi; Liu, Rong; Zhao, Guodong; Li, Qiuyang; Xiao, Chen; Wang, Rong; Li, Shuanglei; Wang, Maoqiang; Liu, Fengyong; Wang, Haiyi; Li, Hongzhao; Ma, Xin; Zhang, Xu

doi:10.1016/j.eururo.2019.04.019

Cited by 74 publications

(56 citation statements)

References 21 publications

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“…The safety and feasibility of robot-assisted laparoscopic IVC thrombectomy have been investigated in our previous studies ( 21 – 23 ). We found that coexisting bland thrombus was not uncommon in RCC patients with IVC tumor thrombus.…”

Section: Discussionmentioning

confidence: 99%

“…In the latter cases, we aim for negative margins by identifying the distal margin of the tumor thrombus and then proceeding to ligate and divide the IVC. Moreover, we perform segmental resection of the IVC when the tumor thrombus is adherent to the vessel wall or if there is no identifiable interface between tumor and bland thrombi ( 22 , 23 ). Association of bland with tumor thrombus should alert the surgical team to a potentially challenging surgical situation.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic accuracy of contrast-enhanced ultrasound for detecting bland thrombus from inferior vena cava tumor thrombus in patients with renal cell carcinoma

Wang

et al. 2020

Int. braz j urol.

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Purpose: To evaluate the role of contrast-enhanced ultrasound (CEUS) in differentiating bland thrombus from tumor thrombus of the inferior vena cava (IVC) in patients with renal cell carcinoma (RCC). Materials and Methods: We retrospectively investigated 30 consecutive patients who underwent robot-assisted radical nephrectomy with IVC thrombectomy and had pathologically confirmed RCC. All patients underwent US and CEUS examination. Two off-line readers observed and recorded thrombus imaging information and enhancement patterns. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value for bland thrombus were assessed. Results: Of the 30 patients, no adverse events occurred during administration of the contrast agent. Early enhancement of the mass within the IVC lumen on CEUS was an indicator of tumor thrombus. Bland thrombus showed no intraluminal flow on CEUS. There were eight (26.7%) patients with bland thrombus, including three level II, two level III, and three level IV. There were three cases with cephalic bland thrombus and five cases with caudal bland thrombus. Three caudal bland thrombi extended to the iliac vein and underwent surgical IVC interruption. Based on no intraluminal flow, for bland thrombus, CEUS had 87.5% sensitivity, 100% specificity, 96.7% accuracy, 100% positive predictive value and 95.6% negative predictive value. Conclusion: Our study demonstrates the potential of CEUS in the differentiation of bland and tumor thrombus of the IVC in patients with RCC. Since CEUS is an effective, inexpensive, and non-invasive method, it could be a reliable tool in the evaluation of IVC thrombus in patients with RCC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of contrast-enhanced ultrasound for detecting bland thrombus from inferior vena cava tumor thrombus in patients with renal cell carcinoma

Wang

et al. 2020

Int. braz j urol.

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“…They concluded that RAE decompressed the venous collaterals, decreased blood loss, and enhanced robotic efficacy. Wang et al [17] reported that the preoperative artery embolization could reduce intraoperative oozing, which was helpful for mobilizing the kidney and manipulating the vessels in robot-assisted IVC thrombectomy. Embolization was necessary and critical for left renal cancer, as the thrombectomy was performed in the left decubitus position.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant instant preoperative renal artery embolization facilitates the radical nephrectomy and thrombectomy in locally advanced renal cancer with venous thrombus: a retrospective study of 54 cases

et al. 2020

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Background: The role of renal artery embolization (RAE) in the therapeutic armamentarium is always controversial. The present study aimed to assess the safety and the surgical outcomes of the instant renal artery embolization (I-RAE) prior to nephrectomy and thrombectomy in patients with locally advanced renal cell carcinoma (RCC) with venous thrombus. Methods: We performed a retrospective analysis of 54 patients treated with nephrectomy and thrombectomy between January 2012 and January 2019. Twenty-four patients were treated with I-RAE before surgery. Thirty patients received surgery alone (non-RAE group). The patient demographics, operation time, blood loss, transfusion requirements, complications, and other surgical parameters were analyzed between the two groups. Results: The mean tumor size in the I-RAE group was significantly larger than that in the non-RAE group (11.1 cm versus 7.9 cm; p = .001). The mean estimated blood loss was significantly lower in the I-RAE group compared to that in the non-RAE group (596 ml versus 827 ml; p = .015), and the patients in the non-RAE group were more likely to receive blood transfusion (red blood cell, RBC units, 4 U versus 6 U, p = .025; plasma volume, 200 ml versus 400 ml, p = .01). No differences were found in operative duration, ICU stay, perioperative complications, and length of postoperative hospitalization. Conclusions: Instant preoperative adjuvant renal artery embolization (I-RAE) is a safe technique. It facilitates nephrectomy and thrombectomy by reducing blood loss, transfusion requirements, and complications of delayed operations, providing urologists with a reliable option for treatment of locally advanced RCC with tumor thrombus.

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“…They concluded that the renal artery embolization decompressed the venous collaterals, decreased blood loss and enhanced robotic e cacy. Wang et al [17] reported that the pre-operative artery embolization could reduce intraoperative oozing, which was helpful for mobilizing the kidney, manipulating the vessels in Robot-assisted Inferior Vena Cava Thrombectomy. The embolization was necessary and critical for left renal cancer, as the thrombectomy was performed in the left decubitus position, it was very di cult to expose the left renal artery.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant instant preoperative renal artery embolization facilitates the radical nephrectomy and thrombectomy in locally advanced renal cancer with venous thrombus: A retrospective study of 54 cases

Tang

chen

Wang

et al. 2020

Preprint

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Background: The role of renal artery embolization (RAE) in the therapeutic armamentarium is always controversial. The present study aimed to assess the safety and the surgical outcomes of the instant renal artery embolization (I-RAE) prior to nephrectomy and thrombectomy in patients with locally advanced renal cell carcinoma (RCC) with venous thrombus.Methods: We performed a retrospective analysis of 54 patients treated with nephrectomy and thrombectomy between January 2012 and January 2019. Twenty-four patients were treated with I-RAE before surgery. Thirty patients received surgery alone (non-RAE group). The patient demographics, operation time, blood loss, transfusion requirements, complications and other surgical parameters were analyzed between the two groups.Results: The mean tumor size in the I-RAE group was significantly larger than that in the non-RAE group (11.1 cm versus 7.9 cm; p = .001). The mean estimated blood loss was significantly lower in the I-RAE group compared to that in the non-RAE group (596 ml versus 827 ml; p = .015), and the patients in the Non-RAE group were more likely to receive blood transfusion (red blood cell, RBC units, 4 U versus 6 U, p = .025; plasma volume, 200 ml versus 400 ml, p = .01). No differences were found in operative duration, ICU stay, perioperative complications and length of postoperative hospitalization. Conclusions: Instant preoperative adjuvant renal artery embolization (I-RAE) is a safe technique. It facilitates nephrectomy and thrombectomy by reducing blood loss, transfusion requirements and complications of delayed operations, providing urologists with a reliable option for treatment of locally advanced RCC with tumor thrombus.

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Robot-assisted Level III-IV Inferior Vena Cava Thrombectomy: Initial Series with Step-by-step Procedures and 1-yr Outcomes

Cited by 74 publications

References 21 publications

Diagnostic accuracy of contrast-enhanced ultrasound for detecting bland thrombus from inferior vena cava tumor thrombus in patients with renal cell carcinoma

Diagnostic accuracy of contrast-enhanced ultrasound for detecting bland thrombus from inferior vena cava tumor thrombus in patients with renal cell carcinoma

Adjuvant instant preoperative renal artery embolization facilitates the radical nephrectomy and thrombectomy in locally advanced renal cancer with venous thrombus: a retrospective study of 54 cases

Adjuvant instant preoperative renal artery embolization facilitates the radical nephrectomy and thrombectomy in locally advanced renal cancer with venous thrombus: A retrospective study of 54 cases

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