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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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Vinzant NJ, Christensen JM, Smith MM, Leibovich BC, Mauermann WJ. Perioperative Outcomes for Radical Nephrectomy and Level III-IV Inferior Vena Cava Tumor Thrombectomy in Patients with Renal Cell Carcinoma. J Cardiothorac Vasc Anesth 2022; 36:3093-3100. [PMID: 35570081 DOI: 10.1053/j.jvca.2022.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/08/2022] [Accepted: 04/17/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study examined the characteristics, intraoperative, and postoperative course of patients undergoing inferior vena cava tumor thrombectomy for metastatic renal cell carcinoma. DESIGN A single-center case series that reported demographic data and intraoperative and postoperative outcomes for patients with renal cell carcinoma undergoing inferior vena cava thrombectomy. SETTING This investigation was performed at a large quaternary referral center. PARTICIPANTS Adult patients (age ≥18) admitted to the authors' hospital from January 1, 2005, to March 10, 2017, undergoing inferior vena cava thrombectomy for level III and IV renal cell carcinoma. INTERVENTIONS No interventions were performed. MEASUREMENTS AND MAIN RESULTS Sixty-five patients who met the inclusion criteria were identified, with 31 patients diagnosed with level III and 34 with level IV renal cell carcinoma. Patients with level IV tumors were significantly more likely to have greater intraoperative blood loss, had longer surgical duration and hospital stays, and had more frequently required blood products, pressors, and cardiopulmonary bypass intraoperatively. Intraoperative transesophageal echo was more frequently used in level IV thrombectomy compared to level III (91.2% v 67.7%). Of patients with level IV thrombus, 41.2% developed postoperative atrial fibrillation compared to only 3.2% with level III thrombus. The 30-day mortality was 4.6% for both groups. CONCLUSIONS Patients undergoing inferior vena cava tumor thrombectomy for renal cell carcinoma had more complex intraoperative and postoperative courses with level IV compared to level III tumor thrombus.
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Affiliation(s)
- Nathan J Vinzant
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jon M Christensen
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Mark M Smith
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Bradley C Leibovich
- Department of Urology (Surgical), Mayo Clinic College of Medicine and Science, Rochester, MN
| | - William J Mauermann
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
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Caño Velasco J, Polanco Pujol L, Hernandez Cavieres J, González García F, Herranz Amo F, Ciancio G, Hernández Fernández C. Controversies in the diagnosis of renal cell carcinoma with tumor thrombus. Actas Urol Esp 2021; 45:257-263. [PMID: 33139067 DOI: 10.1016/j.acuro.2020.09.009] [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: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
Diagnosis and treatment of renal cell carcinoma with venous tumor thrombosis remains a challenge today, requiring multidisciplinary teams, mainly in tumor thrombus levels III-IV. Our objective is to present the various diagnostic techniques used and its controversies. A review of the most relevant related articles between January 2000 and August 2020 has been carried out in PubMed, EMBASE and Scielo. Continuous technological development has allowed progress in its detection, in the approximation of the histological subtype, and in the determination of tumor thrombus level. Regardless of the imaging technique used for its diagnosis (CT, MRI, TEE, ultrasound with contrast), the time elapsed until treatment is vitally important to reduce the risk of complications, some of them fatal, such as pulmonary thromboembolism.
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Rose KM, Navaratnam AK, Faraj KS, Abdul-Muhsin HM, Syal A, Elias L, Moss AA, Eversman WG, Stone WM, Money SR, Davila VJ, Tyson MD, Castle EP. Comparison of Open and Robot Assisted Radical Nephrectomy With Level I and II Inferior Vena Cava Tumor Thrombus: The Mayo Clinic Experience. Urology 2020; 136:152-157. [DOI: 10.1016/j.urology.2019.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/24/2019] [Accepted: 11/02/2019] [Indexed: 10/25/2022]
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Rose KM, Navaratnam AK, Abdul-Muhsin HM, Faraj KS, Eversman SA, Moss AA, Eversman WG, Stone WM, Money SR, Davila VJ, Castle EP. Robot Assisted Surgery of the Vena Cava: Perioperative Outcomes, Technique, and Lessons Learned at The Mayo Clinic. J Endourol 2019; 33:1009-1016. [DOI: 10.1089/end.2019.0429] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Kyle M. Rose
- Department of Urology, Mayo Clinic Arizona, Phoenix, Arizona
| | | | | | - Kassem S. Faraj
- Department of Urology, Mayo Clinic Arizona, Phoenix, Arizona
| | | | - Adyr A. Moss
- Division of Transplant, Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | | | - William M. Stone
- Department of Vascular Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Samuel R. Money
- Department of Vascular Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Victor J. Davila
- Department of Vascular Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Erik P. Castle
- Department of Urology, Mayo Clinic Arizona, Phoenix, Arizona
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Fukazawa K, Fong CT, Gologorsky E. Inferior Vena Cava Tumor Thrombus Dynamics and Perioperative Pulmonary Embolism: A Single-Center Experience. J Cardiothorac Vasc Anesth 2019; 33:2728-2734. [DOI: 10.1053/j.jvca.2019.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/03/2019] [Accepted: 03/04/2019] [Indexed: 12/18/2022]
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Anesthesia for Nephrectomy with Vena Cava Thrombectomy. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lau C, O’Malley P, Gaudino M, Scherr DS, Girardi LN. Resection of Intraabdominal Tumors With Cavoatrial Extension Using Deep Hypothermic Circulatory Arrest. Ann Thorac Surg 2016; 102:836-842. [DOI: 10.1016/j.athoracsur.2016.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/29/2016] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
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Psutka SP, Leibovich BC. Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma. Ther Adv Urol 2015; 7:216-29. [PMID: 26445601 PMCID: PMC4580091 DOI: 10.1177/1756287215576443] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The diagnosis of renal cell carcinoma is accompanied by intravascular tumor thrombus in up to 10% of cases, of which nearly one-third of patients also have concurrent metastatic disease. Surgical resection in the form of radical nephrectomy and caval thrombectomy represents the only option to obtain local control of the disease and is associated with durable oncologic control in approximately half of these patients. The objective of this clinical review is to outline the preoperative evaluation for, and operative management of patients with locally advanced renal cell carcinoma with venous tumor thrombi involving the inferior vena cava. Cornerstones of the management of these complex patients include obtaining high-quality imaging to characterize the renal mass and tumor thrombus preoperatively, with further intraoperative real-time evaluation using transesophageal echocardiography, careful surgical planning, and a multidisciplinary approach. Operative management of patients with high-level caval thrombi should be undertaken in high-volume centers by surgical teams with capacity for bypass and invasive intraoperative monitoring. In patients with metastatic disease at presentation, cytoreductive nephrectomy and tumor thrombectomy may be safely performed with simultaneous metastasectomy if possible. In the absence of level one evidence, neoadjuvant targeted therapy should continue to be viewed as experimental and should be employed under the auspices of a clinical trial. However, in patients with significant risk factors for postoperative complications and mortality, and especially in those with metastatic disease, consultation with medical oncology and frontline targeted therapy may be considered.
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Affiliation(s)
| | - Bradley C Leibovich
- Department of Urology, Mayo Clinic, 200 First Street SW, Gonda 7, Rochester, MN 55905, USA
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Ganeshan D, Morani A, Ladha H, Bathala T, Kang H, Gupta S, Lalwani N, Kundra V. Staging, surveillance, and evaluation of response to therapy in renal cell carcinoma: role of MDCT. ACTA ACUST UNITED AC 2015; 39:66-85. [PMID: 24077815 DOI: 10.1007/s00261-013-0037-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Renal cell carcinoma is the most common malignant renal tumor in the adults. Significant advances have been made in the management of localized and advanced renal cell carcinoma. Surgery is the standard of care and accurate pre-operative staging based on imaging is critical in guiding appropriate patient management. Besides staging, imaging plays a key role in the post-operative surveillance and evaluation of response to systemic therapies. Both CT and MR are useful in the staging and follow up of renal cell carcinoma, but CT is more commonly used due to its lower costs and wider availability. In this article, we discuss and illustrate the role of multi-detector CT in pre-operative staging, post-operative surveillance, and evaluation of response to systemic therapy in renal cell carcinoma.
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González J, Ciancio G. Caval Thrombus in Conjunction with Renal Tumors: Indication for Surgery and Technical Details. Curr Urol Rep 2014; 15:451. [DOI: 10.1007/s11934-014-0451-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Nagy Z, Pánovics J, Szendrői A, Szász AM, Harsányi L, Romics I. Less invasive treatment option for renal carcinoma with venous tumor thrombus. Croat Med J 2014; 55:265-70. [PMID: 24891285 PMCID: PMC4049206 DOI: 10.3325/cmj.2014.55.265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim To retrospectively analyze patients treated by renal tumor and venous tumor thrombus (VTT) removal and to introduce a less stressful and safer surgical method without thoracotomy in Neves level 3 cases. Methods From 2002 to 2011, 33 patients underwent surgery for renal cell cancer combined with tumor thrombus of the inferior vena cava. Preoperative symptoms, tumor-node-metastasis classification of tumors, thrombus extension classified by Neves and Zincke system, types of surgical interventions, complications, postoperative management, and survival results were analyzed. Results Ten patients had level 1, 17 had level 2, and 6 had level 3 thrombi according to Neves and Zincke. In 5 patients with level 3 thrombi, the liver was mobilized without thoracotomy and in 1 patient endoluminal occlusion was utilized. There was no intraoperative mortality. The median survival time of 10 patients who died during follow-up period was 36.6 months (range, 1-116 months). Conclusion Renal cell cancer complicated with tumor thrombus without metastasis can be curable by performing a complete resection. The thrombus level determines the surgical approach and method. Our results confirm that level 3 caval vein tumor thrombus can be safely surgically treated by laparotomy with liver mobilization. Thoracotomy, use of cardiopulmonary bypass, and hypothermic circulatory arrest can be avoided with adequate liver- and vascular surgery methods.
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Affiliation(s)
- Zoltán Nagy
- Zoltán Nagy, Division Head of General Surgery, Department of Surgery, Bajcsy-Zsilinszky Hospital, Building A, Floor I, Maglódi út 89-91, 1106 Budapest, Hungary,
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González J, Andrés G, Martínez-Salamanca JI, Ciancio G. Improving surgical outcomes in renal cell carcinoma involving the inferior vena cava. Expert Rev Anticancer Ther 2014; 13:1373-87. [DOI: 10.1586/14737140.2013.858603] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Preoperative Pulmonary Embolism Does Not Predict Poor Postoperative Outcomes in Patients with Renal Cell Carcinoma and Venous Thrombus. J Urol 2013; 190:452-7. [DOI: 10.1016/j.juro.2013.02.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2013] [Indexed: 11/20/2022]
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The perioperative management of an inferior vena caval tumor thrombus in patients with renal cell carcinoma. Urol Oncol 2013; 31:517-21. [DOI: 10.1016/j.urolonc.2011.03.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 03/14/2011] [Accepted: 03/15/2011] [Indexed: 01/08/2023]
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Lawindy SM, Kurian T, Kim T, Mangar D, Armstrong PA, Alsina AE, Sheffield C, Sexton WJ, Spiess PE. Important surgical considerations in the management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumour thrombus. BJU Int 2012; 110:926-39. [DOI: 10.1111/j.1464-410x.2012.11174.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Nagy Z, Pánovics J, Harsányi L, Szendröi A, Szücs M, Romics I. [Treatment of renal cell carcinoma associated with vena inferior cava tumor thrombus]. Magy Seb 2011; 64:283-8. [PMID: 22169341 DOI: 10.1556/maseb.64.2011.6.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIM Follow-up and review of patients who underwent surgery for renal cell cancer combined with tumor thrombus of the inferior vena cava at the Department of Urology Semmelweis University, Budapest, Hungary. MATERIAL AND METHODS From l998 to 2010 twenty one patients underwent surgery for renal cell cancer combined with tumor thrombus of the inferior caval vein. Preoperative symptoms, TNM classification of the tumors, types of surgical interventions, complications, postoperative management and survival results were involved in the analysis. Mean follow-up period was 39 months, ranging from 3 to 101 months. RESULTS In five cases of level 3 thrombi the liver was mobilized without thoracotomy, and endoluminar occlusion was applied in one case. Intraoperative mortality was 9,5%. Survival time of patients with distant metastases was 12.1 months (3-9). Three patients without metastases died in the follow up period, their survival time was 26.7 months ranging from 22 to 31 months. Eight patients (73%) were alive at the time of the last follow-up. The mean survival time was 5.6 years ranging from 39 to 101 months. CONCLUSION Our results support that level 3 caval vein tumor thrombus can be removed by less aggressive surgical approach and underline the benefit of the surgical intervention without thoracotomy.
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Affiliation(s)
- Zoltán Nagy
- Semmelweis Egyetem I. sz. Sebészeti Klinika, Budapest.
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