Trends and outcomes in contemporary management renal cell carcinoma and vena cava thrombus

Beksaç, Alp Tuna; Shah, Qainat N.; Paulucci, David; Lo, Jing Zhi; Okhawere, Kennedy; Elbakry, Amr A.; Dayal, Bheesham D.; Mehrazin, Reza; Eun, Daniel; Hemal, Ashok K.; Abaza, Ronney; Sfakianos, John P.; Badani, Ketan K.

doi:10.1016/j.urolonc.2019.05.010

Cited by 16 publications

(15 citation statements)

References 16 publications

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“…In an analysis by Beksac et al using the NCDB, the unplanned hospital readmission rate in the O-CT group and R-CT group was similar (Table 4). 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: 87%

“…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%

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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: 87%

Section: Resultsmentioning

confidence: 99%

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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“…It simplifies the procedure, since diversion of the left renal vein into another vessel (such as the inferior mesenteric vein) or IVC reconstruction through grafting is not required ( 17 ), thus avoiding operative time-consuming procedures and the need for prolonged antibiotic and anticoagulation therapy to prevent graft infection and/or occlusion (particularly frequent in the setting of hypercoagulability of malignancy) ( 17 , 24 ). Although robotic assistance allows for increased precision in instrument management, smaller incisions, decreased blood loss, less pain, and earlier recovery ( 25 , 26 ), the need to rely on other specialists for damage control in the event of a possible complication is still necessary. The distance of the surgeon from the operating table may be a disadvantage at the time of a theoretical conversion to open surgery, which can be a problem during the management of higher-level TT, whose inadvertent fragmentation often has devastating consequences for the patient.…”

Section: Discussionmentioning

confidence: 99%

En Bloc Resection of Right Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus Without Caval Reconstruction: Is It Safe to Divide the Left Renal Vein?

et al. 2022

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IntroductionIt has been suggested that inferior vena cava (IVC) reconstruction following resection of retroperitoneal tumors with IVC tumor thrombus (TT) is not required when adequate collateral circulation is present. There are no reports evaluating mid-term effects on renal function in these patients. The purpose of this study was to assess renal function after en bloc resection of right renal cell carcinoma (RCC) with obstructing IVC TT and the possible risks that may arise after left renal vein division.Materials and MethodsA bi-institutional retrospective review was performed over a 15-year period, assessing patients with right RCC and obstructing level II–IV TT. All patients underwent extensive evaluation and cardiology clearance, and informed consent was obtained for right radical nephrectomy and thrombectomy with or without IVC reconstruction with possible cardiopulmonary bypass (CPB). Patient demographics, tumor characteristics, intraoperative factors, complications, length of stay, and patient survival were evaluated. Preoperative creatinine was recorded, as was creatinine on the day of discharge and at 6 and 12 months postoperatively.ResultsTwenty-two patients were included in the study. Median age at surgery was 62.5 (range: 45–79) years, and 19 (86%) of the patients were men. One patient (5%) had a level II thrombus, 14 patients (64%) had a level III thrombus (IIIa, n = 3; IIIb, n = 6; IIIc, n = 3; IIId, n = 2), and seven patients (32%) had a level IV thrombus. Intraoperatively, median estimated blood loss was 1.35 (range: 0.2–25) L. The median length of hospital stay was 11 (range: 5–50) days. Median preoperative creatinine was 1.20 (range: 0.40–2.70) mg/dl, and postoperatively, median creatinine was 1.3 (range: 0.86–2.20) mg/dl. Median creatinine levels at 6 months and 12 months postoperatively were 1.10 (range: 0.5–1.8) mg/dl and 1.40 (range: 0.6–2.0) mg/dl, respectively. Four patients died (range: 0.1–1.3 years), and median postoperative follow-up among the 18 ongoing survivors (at last follow-up) was 1.5 (range: 0.5–7.0) years.ConclusionsResection of right RCC with an obstructing level II–IV TT without reconstruction of the IVC appears to not have a significant adverse effect on mid-term renal function after division of the left renal vein.

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“…Most studies lack a detailed description of the operation technology and repeatability of the methods, especially in the high inferior vena cava dissociation, suspension, occlusion and thrombectomy. Additionally, given the progress of the anatomical understanding of the high inferior vena cava and the improvement in surgical strategies, timely adjustment to the traditional Mayo grade is needed to better guide increasingly optimized clinical surgery [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Step-by-step and orderly lowering of the height of inferior vena cava tumor thrombus is the key to robot-assisted thrombectomy for Mayo III/IV tumor thrombus

Zhao

Zhang

et al. 2022

BMC Cancer

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Background The surgical management of Mayo III/IV tumor thrombi is difficult and risky, and robotic surgery is even more difficult. The purpose of this study was to introduce the step-by-step and orderly lowering of the height of inferior vena cava tumor thrombus, which was the core technique of robot operation for Mayo III/IV tumor thrombus. Method A total of 18 patients were included in this study. The average tumor thrombus height was 2.4 cm above the level of the second porta hepatis (SPH), and 9 patients were prepared for cardiopulmonary bypass (CPB) before surgery. During the operation, the height of the tumor thrombus was lowered orderly for 2-3 times, and the blood flow blocking method was changed sequentially. The CPB was required when tumor thrombus in the atrium; After the height of the thrombus was lowered to the atrium entrance, CPB was stopped and the blood flow was blocked in the upper- and retro-hepatic inferior vena cava (IVC); After the tumor thrombus continued to descend to the lower part of the SPH, liver blood flow could be restored, and then, the blood flow was simply blocked in the retro-hepatic IVC to complete the removal of the thrombus and the repair or resection of the IVC. Finally, the diseased kidney and renal vein were removed. Results All operations were successfully completed, and 2 cases were transferred to laparotomy. Seven cases received CPB, while the other 11 did not. 15 patients underwent two times of the lowering of the tumor thrombus, 2 patients underwent one time and 1 patient underwent three times. The mean liver/IVC dissociation and vascular suspension time was 22.0 min. All patients had less than Clavien-Dindo grade III complications, no serious complications occurred during operation, and no patient died within 90 days. Conclusions The step-by-step and orderly decline of tumor thrombus height is the key to the success of robot Mayo III / IV tumor thrombus surgery. This method can shorten FPH and CPB time and improve the success rate of surgery.

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Trends and outcomes in contemporary management renal cell carcinoma and vena cava thrombus

Cited by 16 publications

References 16 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

En Bloc Resection of Right Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus Without Caval Reconstruction: Is It Safe to Divide the Left Renal Vein?

Step-by-step and orderly lowering of the height of inferior vena cava tumor thrombus is the key to robot-assisted thrombectomy for Mayo III/IV tumor thrombus

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