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Li KP, Chen SY, Wang CY, Li XR, Yang L. Perioperative and oncologic outcomes of minimally-invasive surgery for renal cell carcinoma with venous tumor thrombus: a systematic review and meta-analysis of comparative trials. Int J Surg 2023; 109:2762-2773. [PMID: 37526108 PMCID: PMC10498880 DOI: 10.1097/js9.0000000000000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/06/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The present study aimed to conduct a pooled analysis to compare the perioperative and oncologic outcomes of minimally-invasive radical nephrectomy with tumor thrombus (MI-RNTT) with open radical nephrectomy with tumor thrombus (O-RNTT). METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Four electronic databases (PubMed, Embase, Web of Science, and the Cochrane Library database) were systematically searched to identify relevant studies published in English up to December 2022. The primary outcomes were perioperative results, complications, and oncologic outcomes. Review Manager 5.4 was used for this analysis. RESULTS In total, eight retrospective trials with a total of 563 patients were included. Compared to O-RNTT, MI-RNTT had shorter hospitalization time [weighted mean difference (WMD) -3.58 days, 95% CI: -4.56 to -2.59; P <0.00001), lower volumes of blood loss (WMD -663.32 ml, 95% CI: -822.22 to -504.42; P <0.00001), fewer transfusion rates (OR 0.18, 95% CI: 0.09-0.35; P <0.00001), fewer overall complications (OR 0.33, 95% CI: 0.22-0.49; P <0.00001), and fewer major complications s (OR 0.49, 95% CI: 0.24-1.00; P =0.05). However, operative time, intraoperative complications, mortality rate (intraoperative, within 30 days, and total mortality), overall survival, recurrence-free survival, and cancer-specific survival did not significantly differ between the two groups. CONCLUSIONS MI-RNTT possesses more benefits than O-RNTT in terms of length of hospital stay, blood loss, and complications and provides comparable mortality rates and oncologic outcomes. However, more comprehensive and rigorous research is warranted to further validate the outcomes, which should include a larger sample size and comprehensive data from high-volume medical centers.
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Affiliation(s)
| | | | | | - Xiao-ran Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, People’s Republic of China
| | - Li Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, People’s Republic of China
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Scherñuk J, García Marchiñena PA, Carminatti T, Romeo A, Jurado AM. Renal Cell Carcinoma with Venous Extension: Safety of Laparoscopic Surgery for Thrombus Levels I-IIIa. J Endourol 2023; 37:786-792. [PMID: 37212234 DOI: 10.1089/end.2022.0752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
Background: Novel studies are helping to consider minimally invasive surgery for treating patients with renal cell carcinoma and venous tumor thrombus. Evidence regarding its feasibility and safety is still sparse and does not include a subclassification for level III thrombi. We aim to compare the safety of laparoscopic vs open surgery in patients with levels I-IIIa thrombus. Materials and Methods: This is a cross-sectional comparative study using single-institutional data on adult patients treated surgically between June 2008 and June 2022. Participants were categorized into open and laparoscopic surgery groups. Primary outcome was difference in the incidence of 30-day major postoperative complications (Clavien-Dindo III-V) between groups. Secondary outcomes were differences in operative time, length of hospital stay, intraoperative blood transfusions, delta hemoglobin level, 30-day minor complications (Clavien-Dindo I-II), estimated overall survival, and progression-free survival between groups. A logistic regression model was performed including adjustment for confounding variables. Results: Overall, 15 patients in the laparoscopic group and 25 patients in the open group were included. Major complications occurred in 24.0% of patients within the open group and 6.7% of patients were treated laparoscopically (p = 0.120). Minor complications arose in 32.0% of patients treated with open surgery and in 13.3% of patients treated in the laparoscopic group (p = 0.162). Although not significant, there was a higher perioperative death rate within open surgery cases. The laparoscopic approach presented a crude odds ratio for major complications of 0.22 (95% confidence interval 0.02-2.1, p = 0.191) compared with open surgery. No differences were found between groups regarding oncologic outcomes. Conclusion: Laparoscopic approach for patients with venous thrombus levels I-IIIa seems to be as safe as open surgery.
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Affiliation(s)
- Jordán Scherñuk
- Department of Urology, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Tomás Carminatti
- Department of Urology, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Agustín Romeo
- Department of Urology, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alberto M Jurado
- Department of Urology, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Zhang Y, Bi H, Yan Y, Liu Z, Wang G, Song Y, Zhang S, Liu C, Ma L. Comparative analysis of surgical and oncologic outcomes of robotic, laparoscopic and open radical nephrectomy with venous thrombectomy: a propensity-matched cohort study. Int J Clin Oncol 2023; 28:145-154. [PMID: 36380158 DOI: 10.1007/s10147-022-02265-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide insight into the surgical and oncological outcomes of robotic, laparoscopic and open radical nephrectomy with venous thrombectomy (RALRN-VT, LRN-VT, ORN-VT) in patients with renal tumor and venous thrombus. MATERIALS AND METHODS A propensity-matched retrospective cohort study containing 324 patients with renal tumor and venous thrombus from January 2014 to August 2021 was analyzed. We compared surgical outcomes and we used the Kalan-Meier method to assess the overall survival (OS), tumor-specific survival (TSS), metastasis-free survival (MFS) and local recurrence-free survival (LRFS). The Pearson chi-square test and Fisher exact test, Wilcoxon rank sum test, Cox proportional hazards regression model and log-rank test were used. RESULTS After matching, baseline characteristics were comparable in the RALRN-VT, LRN-VT and ORN-VT group. The RALRN-VT group had the least operative time (median 134 min vs 289 min vs 330 min, P < 0.001), the least blood loss (median 250 ml vs 500 ml vs 1000 ml, P < 0.001) and the fewest packed red blood cells transfusion (median 400 ml vs 800 ml vs 1200 ml, P < 0.001). The ORN-VT group had the highest complication rate (18.2 vs 22.7 vs 43.2%, P = 0.005), the highest Clavien grade (P = 0.001) and the longest postoperative hospital stay (median 7d vs 8d vs 10d, P < 0.001). No significant difference in OS, TSS and MFS between the minimally invasive procedures (MIP, including RALRN-VT and LRN-VT) group and ORN-VT group was found. The hazard ratio of LRFS for the MIP group was 0.20 (95% CI 0.06-0.70, P = 0.01) compared with ORN-VT group. CONCLUSIONS RALRN-VT can result in the best surgical outcomes compared with LRN-VT and ORN-VT. The MIP group had a better LRFS compared with ORN-VT group.
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Affiliation(s)
- Yu Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - Hai Bi
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - Ye Yan
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - GuoLiang Wang
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - YiMeng Song
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China
| | - ShuDong Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China.
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China.
| | - LuLin Ma
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, People's Republic of China.
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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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Zhao X, Liu Z, Zhang H, Li L, Tang S, Wang G, Zhang S, Wang S, Tian X, Ma L. PKUTHLP score: A comprehensive system to predict surgical approach in radical nephrectomy and thrombectomy. Oncol Lett 2020; 20:201-208. [PMID: 32565947 PMCID: PMC7285736 DOI: 10.3892/ol.2020.11571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/26/2020] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to develop an accurate preoperative scoring system to predict the probability of using laparoscopic surgery in radical nephrectomy and thrombectomy. The clinical data of 123 patients with renal cell carcinoma with renal vein or inferior vena cava tumour thrombus admitted to the Department of Urology at Peking University Third Hospital between January 2015 and May 2018 were retrospectively analysed. Univariate and multivariate regression analyses were used to create the scoring system with an emphasis on the area improvement under the receiver operating characteristic curve. A total of 58 (47.2%) patients underwent complete laparoscopic surgery, 56 (45.5%) underwent complete open surgery and 9 (7.3%) underwent laparoscopic conversion to open surgery. The final multivariable model included the following three factors: Clinical node stage (P=0.030), Mayo classification (P<0.001) and tumour diameter (P=0.001). These three variables were then used to construct the score system named Peking University Third Hospital Laparoscopic Probability (PKUTHLP), which ranges from 0-5. The proportion of patients undergoing laparoscopic surgery for each level of the PKUTHLP score were as follows: 0 (n=20), 100%; 1 (n=34), 67.6%; 2 (n=21), 33.3%; 3 (n=21), 19.0%; 4 (n=23), 17.4%; and 5 (n=4), 0.0%. Overall, the PKUTHLP score accurately predicted the probability of using laparoscopic surgery in radical nephrectomy and thrombectomy; however, prospective validation of the PKUTHLP scoring system is required.
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Affiliation(s)
- Xun Zhao
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Liwei Li
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Shiying Tang
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Shumin Wang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
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Zhuo L, Guodong Z, Xun Z, Shiying T, Peng H, Li Z, Liwei L, Shudong Z, Guoliang W, Xiaojun T, Cheng L, Hongxian Z, Lulin M. A modified surgical technique of shortening renal ischemia time in left renal cancer patients with Mayo level II-IV tumor thrombus. BMC Surg 2020; 20:120. [PMID: 32503500 PMCID: PMC7275451 DOI: 10.1186/s12893-020-00769-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022] Open
Abstract
Background To explore the safety and effectiveness of a modified surgical technique which could shorten the time of renal ischemia in left renal cancer and Mayo level II to IV inferior vena cava (IVC) tumor thrombus. Method We retrospectively analyzed the clinical data of 14 cases with left renal cell carcinoma (RCC) and Mayo level II to IV IVC tumor thrombus from February 2015 to July 2019. Preoperative imaging showed that there was no obvious sign of tumor thrombus invading the blood vessel wall. During the surgery, after the right renal artery, the right renal vein and the distal end of IVC were blocked, the balloon catheter was used and the tumor thrombus was removed completely from the IVC. The incision of IVC was closed by Satinsky clamp to make IVC partially blocked. Then the right renal artery and right renal vein were released. The incision of IVC was sutured continuously. At last, the Satinsky clamp and the blocking band at the distal end of the IVC were released. Result There were 8 cases (57.1%) of Mayo level II, 3 cases (21.4%) of Mayo level III and 3 cases (21.4%) of Mayo level IV. The operation was successfully completed in all 14 patients. There were 2 cases (14.3%) operated by complete laparoscopic approach, 8 cases (57.1%) by open approach, and 4 patients (28.6%) by laparoscopic conversion to open approach. The occlusion time of right renal artery and vein (renal ischemia time) was 3 to 15 min, with an average of (6.8 ± 3.2) minutes. The mean time of IVC occlusion was (19.4 ± 4.9) min. Preoperative creatinine was 66 to 130 μmol/L, with an average of (96.6 ± 21.2) μmol/L. One week after operation, serum creatinine was 64 to 632 μmol/L, with an average of (132.4 ± 144.9) μmol/L. Among the 14 cases, 5 (42.9%) had early postoperative complications. Besides one of the 14 patients died in perioperative period, the median follow-up of other 13 cases was 10 months (range: 4–29 months). The 5 (35.7%) of the 14 cases were died of disease. Conclusion This modified procedure was relatively safe and effective in shortening the time of renal ischemia in left RCC patients with Mayo II to IV IVC tumor thrombus.
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Affiliation(s)
- Liu Zhuo
- Urology Department of Peking University Third Hospital, Beijing, 100083, China
| | - Zhu Guodong
- Urology Department of Peking University Third Hospital, Beijing, 100083, China
| | - Zhao Xun
- Urology Department of Peking University Third Hospital, Beijing, 100083, China
| | - Tang Shiying
- Urology Department of Peking University Third Hospital, Beijing, 100083, China
| | - Hong Peng
- Urology Department of Peking University Third Hospital, Beijing, 100083, China
| | - Zhang Li
- Ultrasound Diagnosis Department of Peking University Third Hospital, Beijing, 100083, China
| | - Li Liwei
- Ultrasound Diagnosis Department of Peking University Third Hospital, Beijing, 100083, China
| | - Zhang Shudong
- Urology Department of Peking University Third Hospital, Beijing, 100083, China
| | - Wang Guoliang
- Urology Department of Peking University Third Hospital, Beijing, 100083, China
| | - Tian Xiaojun
- Urology Department of Peking University Third Hospital, Beijing, 100083, China
| | - Liu Cheng
- Urology Department of Peking University Third Hospital, Beijing, 100083, China
| | - Zhang Hongxian
- Urology Department of Peking University Third Hospital, Beijing, 100083, China.
| | - Ma Lulin
- Urology Department of Peking University Third Hospital, Beijing, 100083, China.
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Miao C, Wang Y, Hou C, Chen W, Xu A, Wang Z. Comprehensive managements of metastatic renal tumor with Mayo III inferior vena cava tumor thrombus: a case report. Transl Androl Urol 2020; 9:812-818. [PMID: 32420189 PMCID: PMC7215005 DOI: 10.21037/tau.2019.12.13] [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: 11/06/2022] Open
Abstract
Renal tumor with inferior vena cava (IVC) tumor thrombus still remains one of the most medical challenges in urological oncology. Despite numerous researches reporting the surgical experiences and survivals of this kind of patients, there is still lacking a standard recommended therapy right now. We reported a case of metastatic renal cell carcinoma with Mayo III IVC tumor thrombus who underwent robotic-assisted complete removal of the intracaval thrombus and radical left nephrectomy followed by renal arterial chemoembolization and pazopanib administration. It provides a new scheme and mode of diagnosis and treatment for this kind of patients. The patient was a 50-year-old man with left low-back pain for 20 days diagnosed with left renal tumor and Mayo III IVC tumor thrombus at the earliest. Initially, the patient underwent the renal arterial chemoembolization and targeted treatment to inhibit tumor's progression. After a two-year therapy period, the size of renal mass and lung nodules decreased than before, as well as the IVC tumor thrombus dropped to level II. Considering the efficacy of previous treatments, we performed robot-assisted IVC thrombectomy and radical left nephrectomy for this patient. The post-operative pathological examination confirmed the diagnosis of tumor thrombus as renal clear cell carcinoma. The patients recovered well after surgery and was followed-up for 36 months during the whole treatment course. This case with metastatic renal cell carcinoma (mRCC) and Mayo III IVC tumor thrombus received the interventional therapy, molecular targeted therapy and robot-assisted surgery successively, and acquired satisfying outcome. Patients with mRCC always suffer shorter overall survivals and aggressive progression compared with those localized tumors, therefore it is essential to formulate rational comprehensive treatment and carry out in time following-up.
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Affiliation(s)
- Chenkui Miao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yuhao Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Chao Hou
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wen Chen
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Aiming Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Ge L, Tian X, Ma J, Zhao G, Song Y, Zhang S, Ma L. Surgical treatment for Xp11.2 translocation renal cell carcinoma with venous thrombus: A STROBE-compliant study. Medicine (Baltimore) 2019; 98:e17172. [PMID: 31517871 PMCID: PMC6750303 DOI: 10.1097/md.0000000000017172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The aim of the study was to report the experience and outcomes of Xp11.2 translocation renal cell carcinoma (tRCC) patients with tumor thrombus undergoing radical nephrectomy and thrombectomy.Between January 2017 and December 2017, 66 consecutive patients with RCC and venous thrombus involvement received surgical treatment at Peking University Third Hospital. Of which, 5 patients were confirmed of Xp11.2 tRCC, 61 patients were diagnosed of non-tRCC subtypes including 45 ccRCCs, 10 pRCCs, and 6 other subtypes. Demographic, clinical, operation, pathological and follow-up data were extracted for analysis. Prognostic factors were identified by Cox regression analysis.All the patients received radical nephrectomy and thrombectomy successfully. During a median follow-up of 18 months, 5 patients in non-tRCC group and 1 patient in tRCC group died of disease progression. Survival analysis revealed that Xp11.2 tRCC patients experienced shorter DFS than non-tRCC patients, however, there is no significant difference in OS between two groups. Xp11.2 tRCC histological subtype and presence of metastasis at diagnosis were identified as independent negative factors of DFS by multivariate analysis.Radical nephrectomy with thrombectomy provides an acceptable efficacy for tRCC patients with tumor thrombus extending into the venous system. In addition, multimodality treatment should be considered for advanced Xp11.2 RCCs as this subtype was a negative prognostic factor of DFS.
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Affiliation(s)
| | | | - Jing Ma
- Department of Ultrasonography, Peking University Third Hospital, Haidian District, Beijing, PR China
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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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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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Ebbing J, Wiebach T, Kempkensteffen C, Miller K, Bachmann A, Günzel K, Rieken M, Friedersdorff F, Baumunk D, Weikert S. Evaluation of perioperative complications in open and laparoscopic surgery for renal cell cancer with tumor thrombus involvement using the Clavien–Dindo classification. Eur J Surg Oncol 2015; 41:941-52. [DOI: 10.1016/j.ejso.2015.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/17/2015] [Accepted: 02/28/2015] [Indexed: 10/23/2022] Open
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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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