Robot-assisted versus open surgery for radical nephrectomy with level 1-2 vena cava tumor thrombectomy: a French monocenter experience (UroCCR study #73)

Vuong, Nam‐Son; Ferrière, Jean-Marie; Michiels, C.; Calën, Laura; Tesi, L.; Capon, G.; Bensadoun, H.; Estrade, V.; Robert, G.; Bladou, Franck; Bernhard, Jean‐Christophe

doi:10.23736/s2724-6051.20.04052-7

Cited by 13 publications

(18 citation statements)

References 20 publications

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“…In a matched cohort analysis (matched using age, American Society of Anesthesiologists® score, tumor size and length of IVC thrombus) of 31 patient pairs undergoing robotic or open surgery, the median operative time was significantly shorter in the R-CT group than in the O-CT group (150 vs 230 minutes, p <0.001). 41 In contrast, Rose 43 and Vuong 44 et al found that the median operative time was significantly longer in the R-CT group than in the O-CT group (284 vs 242 minutes, p=0.03, and 350.5 vs 208 minutes, p=0.01, respectively). In a multi-institutional analysis, there was no significant difference in median operative times between O-CT and R-CT (226 vs 260 minutes, p=0.9).…”

Section: Resultsmentioning

confidence: 93%

“…Four studies involving 1,046 patients, with 110 patients undergoing R-CT and 936 patients undergoing O-CT, were included; 41–44 all had a retrospective nonrandomized comparative design and 1 analyzed data in the National Cancer Database (NCDB). The clinicopathological characteristics of the patients in these studies are shown in Table 3 and their perioperative outcomes in Table 4.…”

Section: Resultsmentioning

confidence: 99%

“…42 In the study by Vuong et al, the hospital readmission rate was lower in the R-CT group than in the O-CT group (0% vs 13.3%); however, the difference was not statistically significant (p=0.5). 44…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

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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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“…For PKUTHLP score > 2, we prefer to perform open surgery; otherwise, we select laparoscopic surgery. With the wide application of minimally invasive technology, many low-grade cancer thrombectomies can be completed using a complete laparoscopic or robotic approach; however, the open approach is still an irreplaceable traditional and effective method for treating tumor thrombi ( 22 ). The proportion of open approach surgeries is very high in adrenal tumors associated with venous tumor thrombi.…”

Section: Discussionmentioning

confidence: 99%

Clinical Experience and Management Strategy of Retroperitoneal Tumor With Venous Tumor Thrombus Involvement

Liu

et al. 2022

Front. Oncol.

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BackgroundThis study aims to report the surgical management, complications, and outcomes for patients with retroperitoneal tumor and venous thrombus.MethodsWe retrospectively analyzed 19 cases of retroperitoneal tumor with venous tumor thrombus from August 2015 to March 2021. A new tumor thrombus PUTH-RT grading system was proposed on the basis of the characteristics of the surgical techniques.ResultsTwo cases of PUTH-RT-1a, two cases of PUTH-RT-1b, six cases of PUTH-RT-2, six cases of PUTH-RT-3, and three cases of PUTH-RT-4 were included. Surgeries were successfully performed in all 19 patients. Among them, five cases (26.3%) were operated via a completely laparoscopic approach and 13 cases (68.4%) via an open approach. One case (5.3%) was converted from laparoscopic to open approach. Five cases (26.3%) experienced postoperative complications. All patients were followed for a median of 14 months. Cancer-associated death occurred in three cases. Distant metastases occurred in seven cases.ConclusionsWe propose a new tumor thrombus grading system based on the anatomical characteristics of retroperitoneal tumors with venous tumor thrombus. Retroperitoneal tumor resection and removal of venous tumor thrombi are safe and effective for the treatment of such diseases.

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“…Surgical treatment is a traditional and effective treatment for RCC with inferior vena cava tumor thrombus (IVCTT) [2,3]. With the widespread application of minimally invasive technology in urological tumors, many centers currently perform robot-assisted radical nephrectomy (RARN) with IVC thrombectomy [4][5][6][7][8][9][10]. In the classic surgical procedures of infrahepatic IVCTT, the vascular clamping technique is important in controlling hemorrhage during thrombectomy [7,11].…”

Section: Introductionmentioning

confidence: 99%

Preliminary experience of oblique occlusion technique in robot-assisted infrahepatic inferior vena cava thrombectomy: step-by-step procedures and short term outcomes

Liu

Tang

et al. 2022

BMC Surg

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Background We aimed to compare the oncological outcomes between the oblique occlusion technique and the traditional technique for robot-assisted radical nephrectomy (RARN) with inferior vena cava (IVC) thrombectomy, and to explore the safety and effectiveness of the oblique occlusion technique. Methods Overall, 21 patients with renal cell carcinoma (RCC) and IVC tumor thrombus (TT) were admitted to our hospital from August 2019 to June 2020. All the patients underwent RARN with IVC thrombectomy, of which the IVC oblique occlusion technique was used in 11 patients and traditional occlusion technique was used in 10 patients. The oblique occlusion technique refers to oblique blocking from the upper corner of the right renal vein to the lower corner of the left renal vein using a vessel tourniquet or a vessel clamp (left RCC with IVCTT as an example). Results Compared with patients in the traditional group, those in the oblique group had lower serum creatinine at follow-up (3 month) (95 ± 21.1 vs. 131 ± 30.7 μmol/L, P = 0.03). There was no significant difference in operation time [149 (IQR 143–245) min vs. 148 (IQR 108–261) min, p = 0.86], IVC clamping time [18 (IQR 12–20) min vs. 20 (IQR 14–23) min, p = 0.41], and estimated intraoperative blood loss [300 (IQR 100–800) mL vs. 500 (IQR 175–738) mL, p = 0.51] between both groups. During a 16-month (range, 15–23 months) follow-up period, two cases progressed in the oblique group and three cases progressed in the traditional group. Conclusions The modified IVC oblique occlusion technique procedure is relatively safe and effective in RARN with IVC thrombectomy. The IVC oblique occlusion technique may play a role in the protection of renal function.

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Robot-assisted versus open surgery for radical nephrectomy with level 1-2 vena cava tumor thrombectomy: a French monocenter experience (UroCCR study #73)

Cited by 13 publications

References 20 publications

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

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

Clinical Experience and Management Strategy of Retroperitoneal Tumor With Venous Tumor Thrombus Involvement

Preliminary experience of oblique occlusion technique in robot-assisted infrahepatic inferior vena cava thrombectomy: step-by-step procedures and short term outcomes

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