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Review of Robotic-Assisted Radical Nephrectomy with Inferior Vena Cava Thrombectomy in Renal Cell Carcinoma. Curr Urol Rep 2022; 23:363-370. [PMID: 36454370 DOI: 10.1007/s11934-022-01120-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE OF REVIEW Recent advances in minimally invasive technology have compelled surgeons to perform nephrectomy with inferior vena cava thrombectomy using robotic assistance. Here, we aim to review the data comparing open versus robot-assisted nephrectomy with IVC thrombectomy, as well as review operative robotic techniques for nephrectomy with IVC thrombectomy. RECENT FINDINGS Over the last decade, there have been increasing reports of successful robotic-assisted IVC thrombectomy among skilled robotic surgeons, with case series detailing operative technique, as well as operative and oncologic outcomes for levels I-IV caval thrombus. While there is immense promise in the future of robotic-assisted IVC thrombectomy, further studies with direct comparison to open surgical intervention will be needed to ensure the oncologic principles and outcomes are non-inferior.
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Lv Z, Feng HY, Wang T, Ma X, Zhang X. Preoperative systemic inflammation response index indicates poor prognosis in patients treated with resection of renal cell carcinoma with inferior vena cava tumor thrombus. Urol Oncol 2022; 40:167.e9-167.e19. [PMID: 35042663 DOI: 10.1016/j.urolonc.2021.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/02/2021] [Accepted: 11/29/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate the prognostic value of systemic Inflammation Response Index (SIRI) in patients with renal cell carcinoma and inferior vena cava tumor thrombus (RCC-IVCTT) treated with radical nephrectomy and IVCTT thrombectomy. METHODS We retrospectively reviewed the clinical data of 144 consecutive patients with RCC-IVCTT who received radical nephrectomy and IVCTT thrombectomy at our center from January 2008 to August 2018. Receiver operating characteristic curve analysis was performed to calculate the optimal cutoff value of preoperative SIRI. Kaplan-Meier analysis was used to compare progression-free survival (PFS) and overall survival (OS). Univariable and multivariable Cox proportional hazard models were constructed to identify the independent prognostic factor for OS and PFS. The Harrell concordance index (C-index) was used to assess whether preoperative SIRI could improve the predictive accuracy of the existent prognostic models including Tumor, Node, Metastasis (TNM) stage model, University of California at Los Angeles Integrated Staging System (UISS) model and Stage, Size, Grade and Necrosis (SSIGN) model. RESULTS Elevated preoperative SIRI was significantly correlated with clinicopathologic features that are associated with tumor progression. Patients were divided into a high or low SIRI group by the optimal cutoff value of SIRI. Patients in the high SIRI group had longer postoperative hospital stays and lost more blood during surgery. Kaplan Meier curve showed that high SIRI was correlated with decreased OS (P = 0.036) and PFS (P = 0.039) for patients with RCC-IVCTT after surgery. Increased preoperative SIRI was an independently risk factor for decreased OS (P = 0.038) and PFS (P = 0.021). To evaluate PFS, integrating SIRI to each model led to an increased predictive accuracy of 13.2% for TNM staging model (P = 0.007), 14.4% for UISS model (P = 0.000), 12.9% for SSIGN model (P = 0.003). To evaluate OS, integrating SIRI to each model led to an increased predictive accuracy of 13.2% for TNM staging model (P = 0.006), 12.8% for UISS model (P = 0.004), 12.4% for SSIGN model (P = 0.008). CONCLUSIONS Preoperative SIRI serves as an independent predictor of prognosis for patients with RCC-IVCTT after surgery. Adding preoperative SIRI to the established prognostic models enhance their predictive accuracy.
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Affiliation(s)
- Zheng Lv
- Department of Urology, The Tianjin Third Central Hospital Affiliated of Nankai University; Department of Urology, The third Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hua-Yi Feng
- Medical School of Chinese PLA, Beijing, China; Department of Urology, The third Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Tao Wang
- Medical School of Chinese PLA, Beijing, China; Department of Urology, The third Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xin Ma
- Department of Urology, The third Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China.
| | - Xu Zhang
- Department of Urology, The third Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China.
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3
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Kakoti S, Jena R, Sureka SK, Srivastava A, Mandhani A, Singh UP. Experience with management of renal cell carcinoma with inferior vena cava/right atrial tumor thrombus. Indian J Urol 2021; 37:234-240. [PMID: 34465952 PMCID: PMC8388349 DOI: 10.4103/iju.iju_13_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/04/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: We aimed to present our experience in managing renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus. Methods: Records of all patients aged 18 years and older, with a diagnosis of primary renal masses with IVC thrombus, presenting to our institute from January 2012 to August 2020 were retrospectively reviewed. Patients with tumor thrombus limited only to renal vein were excluded from the analysis. Their hospital course and outcomes were recorded and evaluated for predictors of survival. Results: During the study period, we treated 61 patients with a renal mass and concurrent IVC thrombus and 56 of these underwent surgery. 7 of them had level III and 6 had level IV thrombus. A total of six patients received neoadjuvant tyrosine kinase inhibitor (TKI) therapy and all of them showed a decrease in size and level of tumor thrombus and cardiopulmonary bypass was safely avoided. Fourteen patients had distant metastasis and underwent cytoreductive surgery and of these 12 patients received TKI therapy after surgery with a mean survival of 26.8 months. The overall survival at 2 and 5 years of nonmetastatic group was 81.1% and 47.5% respectively and in metastatic group was 35.1% and 0%, respectively. Poor performance status, distant metastasis, higher T stage, higher thrombus levels, and positive surgical margins were all predictors of decreased survival. Conclusions: Complete surgical resection in both nonmetastatic and metastatic RCC with IVC thrombus has long-term survival benefits. Neoadjuvant TKI therapy, with adequate preoperative planning, helps in decreasing the size of the thrombus and in safely avoiding bypass in level III and IV IVC thrombi.
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Affiliation(s)
- Shitangsu Kakoti
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rahul Jena
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anil Mandhani
- Department of Urology and Renal Transplant, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Uday Pratap Singh
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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4
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Storey B, Grant A, Tiu A. Radical nephrectomy and vena caval thrombectomy with the use of cardiopulmonary bypass and hypothermic circulatory arrest: Experience at a large tertiary institution. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211039147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study aimed to review the experience at a large regional tertiary centre of open radical nephrectomy (RN) with vena caval thrombectomy with cardiopulmonary bypass (CPB) and hypothermic circulatory arrest (HCA) for the management of renal masses. Method: Data on patients with renal masses who had undergone RN and vena caval thrombectomy with CPB and HCA had been prospectively collected at two centres over a 19-year period (2000–2019). Twenty-three consecutive patients were identified and retrospectively analysed for operative and tumour characteristics and for postoperative outcome. Kaplan–Meier survival analysis was performed to compare patient outcomes based on tumour characteristics. Results: Median operating time was 358 minutes (interquartile range (IQR)=94 minutes), median bypass time was 117 minutes (IQR=28.5 minutes) and median circulation arrest time was 25 minutes (IQR=18.5 minutes). The median hospital length of stay was 11 days (IQR=5.3 days). Total complication rate was 52% ( n=12), consisting of four minor and eight major complications (Clavien–Dindo score >IIIa), including one intraoperative death. The overall five-year survival rate was 73% (11/15), with a median follow-up time of 53.1 months. Eleven (48%) patients were surgically cured, with a median follow-up time of 60.1 months (IQR=71.8 months). Disease recurrence was seen in eight (35%) patients, of whom four died. Patients who died survived for a median of 46.5 months. Median survival after the diagnosis of metastatic disease was seven months. Conclusions: We report the largest Australian cohort of RN with vena caval thrombectomy with CPB and HCA. We demonstrate outcomes comparable to major overseas centres, with an overall five-year survival rate of 73%. This suggests that even patients with extensive venal caval thrombus from renal masses can experience long-term survival benefit from RN and venal caval thrombectomy. Level of evidence: Level 3.
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Affiliation(s)
- Benjamin Storey
- Department of Urology, Royal Newcastle Centre, Australia
- University of Newcastle, Australia
| | - Alexander Grant
- Department of Urology, Royal Newcastle Centre, Australia
- University of Newcastle, Australia
- Lake Macquarie Private Hospital, Australia
| | - Albert Tiu
- Department of Urology, Royal Newcastle Centre, Australia
- University of Newcastle, Australia
- Lake Macquarie Private Hospital, Australia
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5
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Liu Z, Hong P, Zhu G, Zhang L, Zhao X, Tang S, Yang F, Tian X, Wang G, Zhang S, Zhang H, Huang Y, Liu C, Liu C, Ma L. Pure retroperitoneal laparoscopic radical nephrectomy and thrombectomy with delayed occlusion of the proximal inferior vena cava (DOPI) technique for renal tumor with level II-III venous tumor thrombus. BMC Cancer 2021; 21:627. [PMID: 34044812 PMCID: PMC8161924 DOI: 10.1186/s12885-021-08392-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/21/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose To explore the safety and effectiveness of delayed occlusion of the proximal inferior vena cava (DOPI) technique in retroperitoneal laparoscopic radical nephrectomy (LRN) and thrombectomy for renal tumor with level II-III venous tumor thrombus (VTT). Materials and methods From August 2016 to October 2018, a total of 145 patients with renal tumor and VTT were admitted to our centre. Seventy-five patients underwent laparoscopic surgery, and 70 patients underwent open surgery. Among these patients, 17 patients underwent retroperitoneal LRN and thrombectomy with the DOPI technique. Clinical data were collected retrospectively, and a descriptive statistical analysis was conducted. Results All the patients successfully underwent retroperitoneal laparoscopic surgery. The mean operation time was 345.9 ± 182.9 min, the mean estimated blood loss was 466.7 ± 245.5 ml. Postoperative complications occurred in three patients, including two patients of Clavien grading system level IVa and one patient of level II. There were no complications related to carbon dioxide pneumoperitoneum, such as gas embolism, acidosis, and subcutaneous emphysema. During 21 months of median follow-up time, no local recurrence was found, and distant metastasis occurred in four patients. Cancer-specific death occurred in two patients. Conclusions The DOPI technique is safe and feasible in the treatment of renal tumor and level II-III VTT. With the DOPI technique, the procedures of dissociating and exposing proximal inferior vena cava are simplified.
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Affiliation(s)
- Zhuo Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Guodong Zhu
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Li Zhang
- Department of Ultrasound Diagnosis, Peking University Third Hospital, Beijing, China
| | - Xun Zhao
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Shiying Tang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Feilong Yang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yi Huang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Chunxia Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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6
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Liu Z, Zhao X, Ge L, Wu B, Tang S, Hong P, Zhang Q, Li L, Peng R, Wang B, Wang G, Zhang S, Tian X, Zhang H, Ma L. Completely laparoscopic versus open radical nephrectomy and infrahepatic tumor thrombectomy: Comparison of surgical complexity and prognosis. Asian J Surg 2020; 44:641-648. [PMID: 33341336 DOI: 10.1016/j.asjsur.2020.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To compare the operation complexity and prognosis of completely laparoscopic versus open radical nephrectomy and infrahepatic tumor thrombectomy. METHODS We reviewed and analyzed the clinical data of 87 patients with infrahepatic tumor thrombus from January 2015 to April 2019 retrospectively. Completely laparoscopic infrahepatic tumor thrombectomy was completed in 41 cases, and open surgery was completed in 46 cases. RESULTS All 41 patients successfully completed laparoscopic operation, and there were no cases of death during the operation. The completely laparoscopic group were older, had smaller renal tumor diameter, shorter median operation time, lower median intraoperative hemorrhage volume, and lower median transfusion volume of suspended red blood cells compared with open surgeries. The proportion of low-level tumor thrombus (Mayo I) in the completely laparoscopic group was higher (63.4%), while the proportion of low-level tumor thrombus in the open surgery group was lower (30.4%) (P = 0.002). The postoperative complications incidence of laparoscopic surgery was 19.5%, which was lower than that of open surgery (47.8%) (P = 0.004). The mean cancer-specific survival time of the laparoscopic surgery group was 36.6 ± 2.5 months, while that of the open surgery group was 32.3 ± 2.7 months (P = 0.277). There was no statistical difference between the two groups. CONCLUSION Although completely laparoscopic radical nephrectomy and infrahepatic tumor thrombectomy is a challenging operation, it could be feasible and safely performed, especially in the hands of highly-experienced laparoscopic urologists for well selected cases.
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Affiliation(s)
- Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, 100191, PR China
| | - Xun Zhao
- Department of Urology, Peking University Third Hospital, Beijing, 100191, PR China
| | - Liyuan Ge
- Department of Urology, Peking University Third Hospital, Beijing, 100191, PR China
| | - Bingjun Wu
- Department of Urology, Peking University Third Hospital, Beijing, 100191, PR China
| | - Shiying Tang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, PR China.
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Beijing, 100191, PR China
| | - Qiming Zhang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, PR China
| | - Liwei Li
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, PR China
| | - Ran Peng
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, 100191, PR China
| | - Binshuai Wang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, PR China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, PR China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, PR China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing, 100191, PR China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, PR China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, 100191, PR China.
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7
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Abstract
Minimally invasive renal surgery has revolutionized the surgical management of renal cancer since the initial report of laparoscopic nephrectomy in 1991. Laparoscopic nephrectomy became the mainstay of management in surgically resectable renal masses since the 1990s. The growing body of literature supporting nephron-sparing surgery over the last two decades has meant that minimally invasive radical nephrectomy (MI-RN) is now the preferred treatment for renal tumors not amenable to partial nephrectomy. While there is a well-described experience with complex radical nephrectomy using standard laparoscopy, robot-assisted surgery has shortened the learning curve and facilitated greater uptake of minimally invasive surgery in difficult surgical scenarios traditionally performed open surgically. Increased experience and expertise with robot-assisted renal surgery has led to expansion of the indications for MI-RN to include larger masses, locally advanced renal masses invading adjacent tissues or regional hilar/retroperitoneal lymph nodes, cytoreductive nephrectomy (CN) in metastatic disease, and concurrent venous tumor thrombectomy for renal vein or inferior vena cava (IVC) involvement. In this article, we review the various surgical techniques and adjunctive procedures associated with MI-RN.
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Affiliation(s)
- Akbar N Ashrafi
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Division of Surgery, North Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Inderbir S Gill
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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8
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Li Q, Li N, Luo Y, Yu H, Ma X, Zhang X, Tang J. Role of intraoperative ultrasound in robotic-assisted radical nephrectomy with inferior vena cava thrombectomy in renal cell carcinoma. World J Urol 2020; 38:3191-3198. [PMID: 32133570 DOI: 10.1007/s00345-020-03141-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To determine the impact of intraoperative ultrasound on robotic-assisted radical nephrectomy with inferior vena cava (IVC) tumor thrombectomy in renal cell carcinoma (RCC). METHODS We retrospectively analyzed intraoperative records of 27 patients with RCC and invasion of the IVC who underwent robotic-assisted nephrectomy with tumor thrombectomy at our center between December 2017 and July 2018. Diagnostic utility and impact of intraoperative transesophageal echocardiography (TEE), intraoperative robotic-assisted ultrasonography, and intraoperative contrast-enhanced ultrasound (CEUS) on surgical management were extracted from the surgical notes and intraoperative ultrasound reports. RESULTS Twenty-seven patients with thrombus had intraoperative ultrasound. Complete tumor removal was achieved in 22 patients, IVC transection in 5 patients, and no residual tumor was observed in all patients. Intraoperative TEE changed the robotic surgical strategy in three patients by monitoring thrombus-level regression. Downstaging of the thrombus level occurred in three patients: Levels IV to III in one and Levels III to II in two. Intraoperative robotic-assisted ultrasonography has facilitated safe VC clamp placement and identification and protection of collateral vessels during IVC transection in five patients. Intraoperative CEUS helped to differentiate the boundary between tumor thrombus (enhancement and small vessel pulsation) and bland thrombus (hypoechoic or no enhancement) in eight (29.6%) patients with bland thrombus. CONCLUSIONS Intraoperative ultrasound is a safe, minimally invasive technique that can provide accurate real-time information regarding the presence and extent of IVC involvement and guidance for placement of a vena cava clamp, confirming the character of the thrombus to plan an optimal surgical approach.
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Affiliation(s)
- Qiuyang Li
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, 100853, China
| | - Nan Li
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yukun Luo
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Hongkai Yu
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xin Ma
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xu Zhang
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jie Tang
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, 100853, China.
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9
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Tan YG, Neo SH, Chen K, Teh GC, Schwentner C, Sim ASP. Key surgical techniques in laparoscopic nephrectomy and thrombectomy for advanced renal cell carcinoma with thrombosis. UROLOGY VIDEO JOURNAL 2019. [DOI: 10.1016/j.urolvj.2019.100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Campi R, Tellini R, Sessa F, Mari A, Cocci A, Greco F, Crestani A, Gomez Rivas J, Fiori C, Lapini A, Gallucci M, Capitanio U, Roupret M, Abaza R, Carini M, Serni S, Ficarra V, Porpiglia F, Esperto F, Minervini A. Techniques and outcomes of minimally-invasive surgery for nonmetastatic renal cell carcinoma with inferior vena cava thrombosis: a systematic review of the literature. MINERVA UROL NEFROL 2019; 71:339-358. [PMID: 30957477 DOI: 10.23736/s0393-2249.19.03396-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Current guidelines recommend considering surgical excision of non-metastatic renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombosis in patients with acceptable performance status. Of note, several authors have pioneered specific techniques for laparoscopic and robotic management of renal cancer with level I-IV IVC thrombosis. EVIDENCE ACQUISITION A systematic review of the English-language literature on surgical techniques and perioperative outcomes of minimally-invasive radical nephrectomy (RN) and IVC thrombectomy for nonmetastatic RCC was performed without time filters using the MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials and Web of Science (WoS) databases in September 2018 according to the PRISMA statement recommendations. EVIDENCE SYNTHESIS Overall, 28 studies were selected for qualitative analysis (N.=13 on laparoscopic surgery, N.=15 on robotic surgery). The quality of evidence according to GRADE was low. Laparoscopic techniques included hand-assisted, hybrid and pure laparoscopic approaches. Most of these series included right-sided tumors with predominantly level I or II IVC thrombi. Similarly, most robotic series reported right-sided RCC with level I-II IVC thrombosis; yet, few authors extended the indication to level III thrombi and to left-sided RCC. Surgical techniques for minimally-invasive IVC thrombectomy evolved over the years, with specific technical nuances aiming to tailor surgical strategy according to both tumor side and thrombus extent. Among the included studies, perioperative outcomes were promising. CONCLUSIONS Minimally-invasive surgery is technically feasible and has been shown to achieve acceptable perioperative outcomes in selected patients with renal cancer and IVC thrombosis. The evidence is premature to draw conclusions on intermediate-long term oncologic outcomes. Robotic surgery allowed to extend surgical indications to more challenging cases with more extensive tumor thrombosis. Nonetheless, global experience on minimally-invasive IVC thrombectomy is limited to high-volume surgeons at high-volume Centers. Future research is needed to prove its non-inferiority as compared to open surgery and to define its benefits and limits.
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Affiliation(s)
- Riccardo Campi
- Department of Urology, Careggi University Hospital, Florence, Italy - .,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy -
| | - Riccardo Tellini
- Department of Urology, Careggi University Hospital, Florence, Italy
| | - Francesco Sessa
- Department of Urology, Careggi University Hospital, Florence, Italy
| | - Andrea Mari
- Department of Urology, Careggi University Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Cocci
- Department of Urology, Careggi University Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Alessandro Crestani
- Unit of Urology, Santa Maria della Misericordia Academic Medical Center Hospital, Udine, Italy
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alberto Lapini
- Department of Urology, Careggi University Hospital, Florence, Italy
| | - Michele Gallucci
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Umberto Capitanio
- Unit of Urology, San Raffaele Hospital IRCCS, Vita-Salute San Raffaele University, Milan, Italy.,Unit of Renal Cancer, Division of Oncology, Urological Research Institute (URI), San Raffaele Hospital IRCCS, Milan, Italy
| | - Morgan Roupret
- Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Ronney Abaza
- Unit of Robotic Urologic Surgery, Ohio Health Dublin Methodist Hospital, Columbus, OH, USA
| | - Marco Carini
- Department of Urology, Careggi University Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi University Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Vincenzo Ficarra
- Department of Human Pathology of Adult and Evolutive Age, University of Messina, Messina, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Andrea Minervini
- Department of Urology, Careggi University Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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11
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Tohi Y, Makita N, Suzuki I, Suzuki R, Kubota M, Sugino Y, Inoue K, Kawakita M. En bloc laparoscopic radical nephrectomy with inferior vena cava thrombectomy: A single-institution experience. Int J Urol 2018; 26:363-368. [PMID: 30508876 DOI: 10.1111/iju.13873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 11/04/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the outcomes of laparoscopic radical nephrectomy with inferior vena cava thrombectomy for right renal cell carcinoma at Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan. METHOD A retrospective review of the clinical records of five patients who underwent laparoscopic radical nephrectomy with inferior vena cava thrombectomy for right renal cell carcinoma between 2013 and 2017 was carried out. The surgical procedure included ligation and cutting of the right renal artery, followed by kidney mobilization. The left renal vein, and the caudal and cephalad sides of the inferior vena cava thrombus were clamped using laparoscopic vascular clamps, and the inferior vena cava was incised. The free kidney and tumor thrombus were placed en bloc in a retrieval bag. Subsequently, the inferior vena cava was laparoscopically closed using a continuous suture. RESULTS The median operative time, pneumoperitoneum time, blood loss and postoperative hospital stay were 316 min, 266 min, 400 mL and 7 days, respectively. The median clamp time was 28 min (range 13-105 min). One patient (20%) required a perioperative blood transfusion. The surgical margin was negative in all patients. Only one patient experienced a major complication (Clavien-Dindo grade ≥3), namely a postoperative hemorrhage requiring transarterial embolism. CONCLUSION En bloc laparoscopic radical nephrectomy with inferior vena cava thrombectomy is a challenging yet feasible procedure for experienced surgeons in carefully selected patients. Further studies of this surgical procedure are required for standardization and safe application.
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Affiliation(s)
- Yoichiro Tohi
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Noriyuki Makita
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Issei Suzuki
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Ryosuke Suzuki
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Masashi Kubota
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yoshio Sugino
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Koji Inoue
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Mutsushi Kawakita
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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12
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Gu L, Ma X, Gao Y, Li H, Li X, Chen L, Wang B, Xie Y, Fan Y, Zhang X. Robotic versus Open Level I-II Inferior Vena Cava Thrombectomy: A Matched Group Comparative Analysis. J Urol 2017; 198:1241-1246. [PMID: 28694078 DOI: 10.1016/j.juro.2017.06.094] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Liangyou Gu
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
- Department of Urology, First Affiliated Hospital of Nanchang University (LC), Nanchang, China
| | - Xin Ma
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
- Department of Urology, First Affiliated Hospital of Nanchang University (LC), Nanchang, China
| | - Yu Gao
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
- Department of Urology, First Affiliated Hospital of Nanchang University (LC), Nanchang, China
| | - Hongzhao Li
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
- Department of Urology, First Affiliated Hospital of Nanchang University (LC), Nanchang, China
| | - Xintao Li
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
- Department of Urology, First Affiliated Hospital of Nanchang University (LC), Nanchang, China
| | - Luyao Chen
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
- Department of Urology, First Affiliated Hospital of Nanchang University (LC), Nanchang, China
| | - Baojun Wang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
- Department of Urology, First Affiliated Hospital of Nanchang University (LC), Nanchang, China
| | - Yongpeng Xie
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
- Department of Urology, First Affiliated Hospital of Nanchang University (LC), Nanchang, China
| | - Yang Fan
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
- Department of Urology, First Affiliated Hospital of Nanchang University (LC), Nanchang, China
| | - Xu Zhang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
- Department of Urology, First Affiliated Hospital of Nanchang University (LC), Nanchang, China
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Kamimura T, Kida K, Takeda M, Sato S, Fujii M, Inoue M, Tsukino H, Mukai S, Nanashima A, Nakamura K, Kamoto T. Surgical intervention for renal cell carcinoma with inferior vena cava extension combined with laparoscopic procedure. Res Rep Urol 2017; 9:107-112. [PMID: 28685130 PMCID: PMC5484623 DOI: 10.2147/rru.s134817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) shows extreme hypervascularity, which may cause significant bleeding during surgery. For this reason, control of arterial blood supply is an important factor in the choice of operative procedure and in avoiding perioperative complications. This case series reports the successful dissection of renal artery in the preliminary stage of laparoscopic procedure in three ccRCC patients with inferior vena cava (IVC) extension. Patient 1 had right renal cell carcinoma (RCC) with level I tumor thrombus through two renal veins, and the renal artery was successfully dissected by retroperitonealscopic approach. Patient 2 had right invasive, immobilized RCC with significant infiltration to IVC and liver. Ligation of renal artery was performed by transperitoneal laparoscopic procedure. Patient 3 had left RCC with level III tumor thrombus and lung metastasis. Ligation of left renal artery and mobilization of peritoneal organs and kidney were performed by transperitoneal laparoscopic surgery. These cases suggest that combined laparoscopic-open surgery for RCC with IVC extension may facilitate early control of arterial blood supply.
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Affiliation(s)
- Toshio Kamimura
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kazutaka Kida
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masashi Takeda
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shunsuke Sato
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masato Fujii
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masahiro Inoue
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiromasa Tsukino
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shoichiro Mukai
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Atsushi Nanashima
- Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kunihide Nakamura
- Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Toshiyuki Kamoto
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Abaza R, Eun DD, Gallucci M, Gill IS, Menon M, Mottrie A, Shabsigh A. Robotic Surgery for Renal Cell Carcinoma with Vena Caval Tumor Thrombus. Eur Urol Focus 2016; 2:601-607. [DOI: 10.1016/j.euf.2017.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 12/18/2016] [Accepted: 01/04/2017] [Indexed: 11/25/2022]
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Wang B, Li H, Ma X, Zhang X, Gu L, Li X, Fan Y, Gao Y, Liu K, Zhu J. Robot-assisted Laparoscopic Inferior Vena Cava Thrombectomy: Different Sides Require Different Techniques. Eur Urol 2015; 69:1112-9. [PMID: 26706105 DOI: 10.1016/j.eururo.2015.12.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/01/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND The safety and feasibility of robot-assisted laparoscopic inferior vena cava (IVC) thrombectomy (RAL-IVCTE) have been investigated in limited reports. OBJECTIVE To share our initial experience with RAL-IVCTE, as well as describe respectively the detailed techniques for RAL-IVCTE for left or right renal cell carcinoma (RCC). DESIGN, SETTING, AND PARTICIPANTS From May 2013 to July 2014, 17 patients with RCC involving IVC tumor thrombus were admitted to our hospital. SURGICAL PROCEDURE For right RCC, the caudal IVC, left renal vein, and cephalic IVC were sequentially clamped. The IVC wall was cut, and the thrombus was removed. For left RCC, the left renal vein, which included the thrombus, was ligated with Endo-GIA. The caudal IVC, right renal artery, right renal vein, and cephalic IVC were sequentially clamped. MEASUREMENTS The detailed techniques for RAL-IVCTE for different sides were described and the perioperative outcomes recorded. RESULTS AND LIMITATIONS The operations were successfully performed without open conversion. Median operation time was 131min (100-150min) and 250min (190-275min) for the right and left RCC, respectively. Median estimated blood loss was 240ml (145-320ml). Median IVC blocking time was 17min (12-25min). For left RCC, median warm ischemia time for the right kidney was 18min (14-22min). A grade IV complication-bleeding from tributaries of the IVC-developed in one case and was successfully resolved with intraoperative endoscopic suture. CONCLUSIONS RAL-IVCTE is safe and feasible. For left RCC involving IVC thrombus, right renal warm ischemia time is necessary during the procedure, requiring a more advanced technical skill. The therapeutic effect and overall survival rate require further investigation with a larger sample size and longer follow-up. PATIENT SUMMARY Robot-assisted laparoscopic inferior vena cava thrombectomy is technically challenging but safe and feasible. The therapeutic effect needs further investigation.
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Affiliation(s)
- Baojun Wang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xin Ma
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
| | - Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xintao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Yang Fan
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Yu Gao
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Kan Liu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Jie Zhu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
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Prognostic Outcomes and Risk Factors for Patients with Renal Cell Carcinoma and Venous Tumor Thrombus after Radical Nephrectomy and Thrombectomy: The Prognostic Significance of Venous Tumor Thrombus Level. BIOMED RESEARCH INTERNATIONAL 2015; 2015:163423. [PMID: 26421277 PMCID: PMC4573224 DOI: 10.1155/2015/163423] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 04/24/2015] [Indexed: 11/28/2022]
Abstract
Introduction. To evaluate the prognostic outcomes and risk factors for renal cell carcinoma (RCC) patients with venous tumor thrombus in China. Materials and Methods. We reviewed the clinical information of 169 patients who underwent radical nephrectomy and thrombectomy. Overall and cancer-specific survival rates were analyzed. Univariate and multivariate analyses were used to investigate the potential prognostic factors. Results. The median survival time was 63 months. The five-year overall survival and cancer-specific survival rate were 53.6% and 54.4% for all patients. For all patients, significant survival difference was only observed between early (below hepatic vein) and advanced (above hepatic vein) tumor thrombus. However, significant differences existed between both RV/IVC and early/advanced tumor thrombus groups in N0M0 patients. Multivariate analysis demonstrated that higher tumor thrombus level (p = 0.016, RR = 1.58), N (p = 0.013, RR = 2.60), and M (p < 0.001, RR = 4.14) stages and adrenal gland invasion (p = 0.001, RR = 4.91) were the most significant negative prognostic predictors. Conclusions. In this study, we reported most cases of RCC patients with venous extension in China. We proved that patients with RCC and venous tumor thrombus may have relative promising long-term survival rate, especially those with early tumor thrombus.
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Sood A, Jeong W, Barod R, Bahnson E, Kirura P, Abdollah F, Bhandari M, Bahnson R, Menon M. Robot-assisted hepatic mobilization and control of suprahepatic infradiaphragmatic inferior vena cava for level 3 vena caval thrombectomy: An IDEAL stage 0 study. J Surg Oncol 2015; 112:741-5. [DOI: 10.1002/jso.23980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/04/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Akshay Sood
- Vattikuti Urology Institute; Henry Ford Health System; Detroit Michigan
| | - Wooju Jeong
- Vattikuti Urology Institute; Henry Ford Health System; Detroit Michigan
| | - Ravi Barod
- Vattikuti Urology Institute; Henry Ford Health System; Detroit Michigan
| | - Eamonn Bahnson
- Department of Urology; University of Cincinnati; Cincinnati Ohio
| | - Parfait Kirura
- Department of Urology; Ohio State University; Columbus Ohio
| | - Firas Abdollah
- Vattikuti Urology Institute; Henry Ford Health System; Detroit Michigan
| | - Mahendra Bhandari
- Vattikuti Urology Institute; Henry Ford Health System; Detroit Michigan
| | - Robert Bahnson
- Department of Urology; Ohio State University; Columbus Ohio
| | - Mani Menon
- Vattikuti Urology Institute; Henry Ford Health System; Detroit Michigan
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18
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Shao P, Li J, Qin C, Lv Q, Ju X, Li P, Shao Y, Ni B, Yin C. Laparoscopic Radical Nephrectomy and Inferior Vena Cava Thrombectomy in the Treatment of Renal Cell Carcinoma. Eur Urol 2014; 68:115-22. [PMID: 25534934 DOI: 10.1016/j.eururo.2014.12.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/03/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Radical nephrectomy with inferior vena cava (IVC) thrombectomy is the preferred treatment for renal cell carcinoma (RCC) with IVC thrombus. However, IVC thrombectomy using a laparoscopic approach has not been reported for high-level thrombi. OBJECTIVE To describe the surgical technique for laparoscopic IVC thrombectomy in patients with different thrombus levels and to assess its safety and feasibility. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of medical records for 11 patients with right-side RCC, including six patients with level II IVC thrombus and five patients with level IV thrombus. SURGICAL PROCEDURE Laparoscopic thrombectomy for level II thrombus was performed after clamping the infrarenal IVC, left renal vein, and infrahepatic IVC. Laparoscopic thrombectomy and thoracoscope-assisted open atriotomy for level IV thrombus were performed after establishing cardiopulmonary bypass and clamping the infrarenal IVC, left renal vein, and hepatoduodenal ligament. MEASUREMENTS The intraoperative variables, postoperative complications, and surgical outcomes were assessed. RESULTS AND LIMITATIONS The median operative time was 210min. The median IVC clamping time for patients with level II and level IV thrombus was 16.5 and 31min, respectively. The median estimated blood loss was 510ml, and no major intraoperative or postoperative complications occurred. One patient with level IV thrombus died of brain metastasis 6 mo after the operation, and the remaining ten patients had no local recurrence or distant metastasis during a median follow-up period of 31 mo. CONCLUSIONS Laparoscopic IVC thrombectomy for level II thrombus and well-selected level IV thrombus may be a safe and technically feasible alternative to open surgery. PATIENT SUMMARY We studied the treatment of patients with an inferior vena cava thrombus at different levels using a laparoscopic approach. This technique was safe and feasible in well-selected patients.
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Affiliation(s)
- Pengfei Shao
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Li
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Qin
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Lv
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaobing Ju
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pu Li
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yongfeng Shao
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Buqing Ni
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Changjun Yin
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Karam JA, Wood CG, Compton ZR, Rao P, Vikram R, Ahrar K, Matin SF. Salvage surgery after energy ablation for renal masses. BJU Int 2014; 115:74-80. [DOI: 10.1111/bju.12743] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Jose A. Karam
- Department of Urology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Christopher G. Wood
- Department of Urology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Zachary R. Compton
- Department of Urology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Priya Rao
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Raghunandan Vikram
- Department of Diagnostic Radiology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Kamran Ahrar
- Interventional Radiology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Surena F. Matin
- Department of Urology; The University of Texas MD Anderson Cancer Center; Houston TX USA
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20
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Abstract
Robotic surgery has been applied to increasingly complex urologic procedures since its initial widespread adoption for prostatectomy. While laparoscopic nephrectomy was initially reported over 2 decades ago, renal tumors involving the inferior vena cava (IVC) appeared to be a limitation to the application of laparoscopy. Laparoscopic management had only been reported in a limited fashion for short tumor thrombi not requiring cross-clamping of the IVC. The first robotic nephrectomy for renal cancer with IVC tumor thrombus was performed in 2008 with the first series reported in 2011, including for larger tumor thrombi requiring IVC cross-clamping for thrombus extraction. Since then, several surgeons at various institutions have adopted robotic surgery for these complex procedures. With experience and meticulous surgical technique, the procedure can be reproduced in properly selected cases. Further adoption and reports of multi-institutional experiences are necessary to validate this still relatively new procedure, and such work is already underway.
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Affiliation(s)
- Ronney Abaza
- Department of Urology, Ohio Health Dublin Methodist Hospital, Dublin, Ohio, USA
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21
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Rendon RA, Kapoor A, Breau R, Leveridge M, Feifer A, Black PC, So A. Surgical management of renal cell carcinoma: Canadian Kidney Cancer Forum Consensus. Can Urol Assoc J 2014; 8:E398-412. [PMID: 25024794 DOI: 10.5489/cuaj.1894] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Anil Kapoor
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON
| | - Rodney Breau
- Division of Urology, University of Ottawa, Ottawa, ON
| | - Michael Leveridge
- Departments of Urology and Oncology, Queen's University, Kingston, ON
| | | | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
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22
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Wang W, Wang L, Xu J, Adams TS, Tian Y, Lv W. Pure Retroperitoneal Laparoscopic Radical Nephrectomy for Right Renal Masses with Renal Vein and Inferior Vena Cava Thrombus. J Endourol 2014; 28:819-24. [DOI: 10.1089/end.2014.0066] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Wenying Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Li Wang
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jianfeng Xu
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Tamara S. Adams
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wencheng Lv
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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23
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Tang Q, Wang T, Li X, Zhang Z, Song G, He Z, Zhou L. Renal cell carcinoma with infrahepatic vena caval tumor thrombus treated with a novel combined retroperitoneal and transperitoneal pure laparoscopic procedure. Urology 2014; 83:e9-10. [PMID: 24767537 DOI: 10.1016/j.urology.2014.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 12/30/2013] [Accepted: 01/24/2014] [Indexed: 11/30/2022]
Abstract
A 61-year-old male patient presented with intermittent gross hematuria. A right renal mass with infrahepatic vena caval tumor thrombus was found using magnetic resonance imaging. We undertook a novel combined retroperitoneal and transperitoneal pure laparoscopic nephrectomy with vena caval thrombectomy for this patient. The patient recovered well after surgery and discharged on day 6. A clear cell renal cell carcinoma with venous extension was confirmed by pathologic assay. To our knowledge, this is the first report of such a novel hybrid surgical strategy.
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Affiliation(s)
- Qi Tang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Tianyu Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zheng Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Gang Song
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhisong He
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
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24
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Wang W, Xu J, Adams TS, Tian Y, Lv W. Pure Retroperitoneal Laparoscopic Radical Nephrectomy for Left Renal Cell Carcinoma with Differential Extensions of Level I Renal Vein Tumor Thrombus. J Endourol 2014; 28:312-7. [PMID: 24093212 DOI: 10.1089/end.2013.0544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Wenying Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jianfeng Xu
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Tamara S. Adams
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wencheng Lv
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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26
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Aufderklamm S, Todenhöfer T, Hennenlotter J, Mischinger J, Böttge J, Rausch S, Halalsheh O, Stenzl A, Gakis G, Schwentner C. Postchemotherapy laparoscopic retroperitoneal lymph node dissection for nonseminomatous germ cell tumors infiltrating the great vessels. J Endourol 2014; 28:668-74. [PMID: 24422683 DOI: 10.1089/end.2013.0755] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Laparoscopic retroperitoneal lymph node dissection (L-RPLND) is an alternative in patients with metastatic nonseminomatous germcell tumors (NSGCT) necessitating resection of residuals postchemotherapy. With the advancement of laparoscopic vascular surgery, prospective management of the great vessels has become feasible and safe. We present our experience with L-RPLND in NSGCT residuals with significant vascular involvement necessitating intracorporeal reconstruction. PATIENTS AND METHODS We have retrospectively identified 19 NSGCT patients (mean age 27 years) who presented with residuals postchemotherapy. A bilateral L-RPLND was performed in all men. Infiltration of the great vessels was confirmed intraoperatively. Prospective vascular control and temporary clamping was performed in all cases. The vessel wall was reconstructed using vascular surgery techniques. All patients had at least clinical stages of IIA or higher. Follow-up was obtained in all. RESULTS There were no conversions to open surgery. The mean size of the residuals after chemotherapy was 3.87 cm (1.5-9.7 cm). The mean blood loss was 310 mL (50-1000 mL). Mean hospital stay was 6 days (3-9 days). There were no perioperative complications exceeding grade II according to the Clavien-Dindo classification. Distant or in-field recurrence (mean observational period 18 months) did not develop in any patient. CONCLUSION Laparoscopic RPLND may be considered a safe alternative concept for the management of post-chemotherapy NSGCT residuals involving the great vessels. Bilateral L-RPLND in patients with vascular infiltration is feasible and reproducible when laparoscopic vascular surgery can be reliably handled. All standard principles of open surgery are respected, and initial oncologic results are promising.
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27
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Xu B, Zhao Q, Jin J, He ZS, Zhou LQ, Zhang Q. Laparoscopic Versus Open Surgery for Renal Masses with Infrahepatic Tumor Thrombus: The Largest Series of Retroperitoneal Experience from China. J Endourol 2014; 28:201-7. [PMID: 24032413 DOI: 10.1089/end.2013.0519] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Ben Xu
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, Beijing China
| | - Qiang Zhao
- Department of Urology, Peking University Cancer Hospital, Beijing Cancer Hospital & Institute, Beijing, China
| | - Jie Jin
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, Beijing China
| | - Zhi-song He
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, Beijing China
| | - Li-qun Zhou
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, Beijing China
| | - Qian Zhang
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, Beijing China
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28
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Bansal RK, Tu HYV, Drachenberg D, Shayegan B, Matsumoto E, Whelan JP, Kapoor A. Laparoscopic management of advanced renal cell carcinoma with renal vein and inferior vena cava thrombus. Urology 2014; 83:812-6. [PMID: 24411219 DOI: 10.1016/j.urology.2013.09.060] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 08/25/2013] [Accepted: 09/27/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To report the results and oncological efficacy of laparoscopic radical nephrectomy (LRN) in patients with renal cell carcinoma with renal vein and inferior vena cava thrombus. METHODS We performed retrospective record review of 41 patients who underwent LRN along with venous thrombectomy at 2 Canadian centers from 2002 to 2012 by dedicated laparoscopic surgeons. RESULTS The mean age and body mass index of the 41 study patients (34 males and 7 female) were 64.4 years and 28.7 kg/m(2), respectively. Median tumor size was 9.3 cm; 39 patients had renal vein thrombus, and 2 had inferior vena cava thrombus. Nine patients (22%) had metastatic disease to begin with and underwent laparoscopic cytoreductive nephrectomy. Median estimated blood loss, operative time, and length of stay were 100 mL (range, 50-400 mL), 134.5 minutes (range, 99-183 minutes), and 4 days (range, 4-6 days), respectively. There were 4 (9.7%) grade 2 complications. There was no intraoperative death. Mean duration of follow-up was 42 months (range, 6-107 months). Of 32 patients with localized disease, 4 (12.5%) died of progressive disease, 3 (9.3%) died of unrelated causes, and 3 patients (9.3%) were lost to follow-up. Twenty-two patients (68.7%) were alive at a mean follow-up of 47 months. CONCLUSION LRN and venous thrombectomy for advanced renal tumors with venous thrombus are safe procedures in experienced hands with significant laparoscopic skills. The short-term oncological data are encouraging and advocate the efficacy of this procedure in this subset of patients, although longer follow-up is required in larger number of patients to further define its role.
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Affiliation(s)
- Rahul Kumar Bansal
- McMaster Institute of Urology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Hin Yu Vincent Tu
- McMaster Institute of Urology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Darrel Drachenberg
- Department of Surgery, Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bobby Shayegan
- McMaster Institute of Urology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Edward Matsumoto
- McMaster Institute of Urology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - J Paul Whelan
- McMaster Institute of Urology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Anil Kapoor
- McMaster Institute of Urology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.
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Lee JY, Mucksavage P. Robotic radical nephrectomy with vena caval tumor thrombectomy: experience of novice robotic surgeons. Korean J Urol 2012; 53:879-82. [PMID: 23301135 PMCID: PMC3531644 DOI: 10.4111/kju.2012.53.12.879] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 09/22/2012] [Indexed: 11/18/2022] Open
Abstract
The introduction of robot-assisted laparoscopic surgery has facilitated the application of minimally invasive surgical techniques to many complex reconstructive and extirpative procedures. Even early on in their learning experience, robotic surgeons have been able to complete procedures using a minimally invasive approach, but would not have been able to do so using a purely laparoscopic technique. Although the open surgical approach remains the standard of care in the management of large renal tumors presenting with a thrombus within the vena cava, robot-assisted surgery may provide the precision and dexterity necessary to allow for the safe application of minimally invasive techniques to such complex clinical scenarios, perhaps even by relatively novice robotic surgeons. We describe the management of a large renal mass with vena caval thrombus (cT3b), which required complete cross-clamping of the vena cava, with the use of a purely robot-assisted laparoscopic approach.
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Affiliation(s)
- Jason Y Lee
- Department of Urology, University of California Irvine Medical Center, University of California Irvine, Orange, CA, USA
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Kulkarni J, Jadhav Y, Valsangkar RS. IVC Thrombectomy in Renal Cell Carcinoma-Analysis of Out Come Data of 100 Patients and Review of Literature. Indian J Surg Oncol 2012; 3:107-13. [PMID: 23730099 PMCID: PMC3392477 DOI: 10.1007/s13193-011-0114-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 12/06/2011] [Indexed: 12/27/2022] Open
Abstract
To review our experience of RCC with IVC thrombus in terms of clinical presentation, principles of surgical management in contemporary era, also an impact of clinico-pathological factors on prognosis. Total 100 patients who underwent radical nephrectomy and IVC thrombectomy between 1991-2008 were included in this retrospective analysis. Data was analysed in terms of clinical pathological factors, survivals and compared with contemporary literature. The extent tumour thrombus was infrahepatic in 58 retro hepatic in 28 and suprahepatic in 14 patients including 6 with right atrial thrombus. The immediate postoperative mortality was 2% and incidence of major postoperative non fatal complications was 38%, which were managed conservatively. The overall and disease free 5 year survival was 63% and 55%. Further amongst the histological types, patients with clear cell tumours had the best (DFS- 71.42%), and those with papillary had the poor (DFS- 30.76%) outcome. Grade II tumors had better survivals as compared to grade IV (DFS 75.39% vs 23.52%, p < 0.05). Loco- regional extent wise 74% patients without perinephric fat invasion were free from disease at 5 years as compared to 30% of those who had perinephric fat invasion (p < 0.01). Similarly 5 year DFS was 76.11% in patients with negative nodes as compared to 12% in positive nodes (p < 0.01). In conclusion radical nephrectomy with IVC thrombectomy still remains the most effective therapeutic option in management in this clinical setting. Although this is complicated surgery success with multi disciplinary approach excellent survival outcome can be obtained. Further pathological factors, such as loco-regional spread and grade of tumor, rather than clinical factors influence long term survival.
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Affiliation(s)
- Jagdeesh Kulkarni
- Department of Urology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra India
| | - Yogesh Jadhav
- Department of Urology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra India
| | - Rohan S. Valsangkar
- Department of Urology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra India
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Abaza R. Initial Series of Robotic Radical Nephrectomy with Vena Caval Tumor Thrombectomy. Eur Urol 2011; 59:652-6. [DOI: 10.1016/j.eururo.2010.08.038] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 08/25/2010] [Indexed: 12/11/2022]
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32
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Robotic surgery and minimally invasive management of renal tumors with vena caval extension. Curr Opin Urol 2011; 21:104-9. [DOI: 10.1097/mou.0b013e32834350ff] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Current world literature. Curr Opin Urol 2011; 21:166-72. [PMID: 21285721 DOI: 10.1097/mou.0b013e328344100a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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