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Chen K, Yu L, Ge L, Deng S, Zhang F, Wang G, Tian X, Zhang H, Zhang S. A nomogram predicting intraoperative adverse events during minimally invasive radical nephrectomy and thrombectomy. Surg Endosc 2024; 38:5891-5902. [PMID: 39168857 DOI: 10.1007/s00464-024-11041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/30/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND To define the incidence and independent predictive factors of intraoperative adverse events (IOAEs) after minimally invasive radical nephrectomy and thrombectomy (RNAT) and to determine the impact of intraoperative adverse events on oncological outcomes. PATIENTS AND METHODS A total of 294 patients underwent minimally invasive RNAT from January 2010 to December 2023 in our center were included. IOAEs are defined as any deviation from the normal surgical procedure during the operation course. Multivariate logistic regression analysis was performed to identify the independent predictive factors of IOAEs. The Kaplan-Meier curves was used to compare overall survival and cancer-specific survival between patients with IOAEs or not. RESULTS Seventy-four IOAEs occurred in 57 of 294 patients (19.4%) and the most frequent IOAEs were conversion to open surgery (42/74, 56.7%), followed by excessive hemorrhage (20/74, 27.0%). In multivariate logistic analysis, side (OR 0.0929; 95%Cl 0.0367-0.2160; p < 0.001), operation approach (OR 0.1762; 95%Cl 0.06828-0.4109; p < 0.001), and Mayo grade (OR 6.321; 95%Cl 3.846-11.13; p < 0.001) were independent predictive predictors of IOAEs during minimally invasive RNAT. IOAEs (OR 2.713; 95%Cl 1.242-5.897; p = 0.012) was an independent risk factor of the occurrence of postoperative complications. Between the patients with IOAEs or not, neither overall survival (OS) nor cancer-specific survival (CSS) showed statistical differences. Patients with postoperative complications show shorter OS and CSS. CONCLUSION We found that the independent predictive factors of minimally invasive RNAT were side, operation approach and Mayo grade, and it is a risk factor of the occurrence of postoperative complications. In addition, the occurrence of IOAEs had no effect on long-term oncological outcomes.
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Affiliation(s)
- Kewei Chen
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Le Yu
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Liyuan Ge
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Shaohui Deng
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Fan Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China.
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Kowal P, Ratajczyk K, Bursiewicz W, Trzciniecki M, Marek-Bukowiec K, Rogala J, Kowalskyi V, Dragasek J, Botikova A, Kruzliak P, Mytsyk Y. Differentiation of solid and friable tumour thrombus in patients with renal cell carcinoma: The role of MRI apparent diffusion coefficient. Adv Med Sci 2024; 69:434-442. [PMID: 39284498 DOI: 10.1016/j.advms.2024.09.002] [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: 01/17/2024] [Revised: 03/12/2024] [Accepted: 09/13/2024] [Indexed: 09/27/2024]
Abstract
PURPOSE Inferior vena cava (IVC) involvement by renal cell carcinoma (RCC) is associated with a higher disease stage and is considered a risk factor for poor prognosis. This study aimed to investigate the role of the apparent diffusion coefficient (ADC) of MRI 3D texture analysis in the differentiation of solid and friable tumour thrombus in patients with RCC. MATERIALS AND METHODS The study involved 27 patients with RCC with tumour thrombus in the renal vein or IVC, surgically treated with nephrectomy and thrombectomy and in whom preoperatively abdominal MRI including the DWI sequence was conducted. For 3D texture analysis, the ADC map was used, and the first-order radiomic features were calculated from the whole volume of the thrombus. All tumour thrombi were histologically classified as solid or friable. RESULTS The solid and friable thrombus was detected in 51.9 % and 48.1 % of patients, respectively. No differences in mean values of range, 90th percentile, interquartile range, kurtosis, uniformity and variance were found between groups. Equal sensitivity and specificity (93 % and 69 %, respectively) of ADC mean, median and entropy in differentiation between solid and friable tumour thrombus, with the highest AUC for entropy (0.808), were observed. Applying the skewness threshold value of 0.09 allowed us to achieve a sensitivity of 86 % and a specificity of 92 %. CONCLUSIONS In patients with RCC and tumour thrombus in the renal vein or IVC, the 3D texture analysis based on ADC-map allows for precise differentiation of a solid from a friable thrombus.
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Affiliation(s)
- Paweł Kowal
- Department of Urology, Regional Specialist Hospital, Wroclaw, Poland.
| | | | - Wiktor Bursiewicz
- Department of Urology, Regional Specialist Hospital, Wroclaw, Poland
| | | | | | - Joanna Rogala
- Department of Pathology, Regional Specialist Hospital, Wroclaw, Poland
| | - Vasyl Kowalskyi
- Department of Oncology and Radiology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Jozef Dragasek
- Faculty of Medicine, Pavol Jozef Safarik University and University Hospital, Kosice, Slovakia
| | - Andrea Botikova
- Faculty of Health and Social Work, Trnava University, Trnava, Slovakia
| | - Peter Kruzliak
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czech Republic.
| | - Yulian Mytsyk
- Department of Urology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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Cheng G, Zhang X. Experiences of robot assisted thrombectomy with 2-year follow-up. Int J Med Robot 2023:e2611. [PMID: 38131413 DOI: 10.1002/rcs.2611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/12/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND No consensus has been reached on operative procedures since a limited case series of robot-assisted inferior vena cava thrombectomy (RA-IVCT) and robot-assisted radical nephrectomy (RA-RN) have been described. METHODS The clinical data of 21 patients who underwent RA-IVCT and RA-RN were retrieved from the database. Preoperative preparation was used for assessment of the tumour. Surgical procedures were recorded, and operative skills were summarised. RESULTS The median IVC clamping time was 23 min, and IVC wall invasion was pathologically found in 2 cases. The mean postoperative hospital stay was 8.4 days and most patients recovered to full ambulation and oral feeding on the fourth day. None of the patients had liver or kidney dysfunction at the last follow-up (median, 24 months). CONCLUSION RA-IVCT presents technical challenges to surgeons. IVC control is an important part of the surgical process and different sides require different techniques.
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Affiliation(s)
- Gong Cheng
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urologic Surgery, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoping Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urologic Surgery, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Tathireddy H, Rice D, Martens K, Shivakumar S, Shatzel J. Breaking down tumor thrombus: Current strategies for medical management. Thromb Res 2023; 230:144-151. [PMID: 37722206 PMCID: PMC11027429 DOI: 10.1016/j.thromres.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/13/2023] [Accepted: 09/11/2023] [Indexed: 09/20/2023]
Abstract
Tumor thrombus, the intravascular extension of tumor into adjacent blood vessels, is frequently encountered in patients with renal cell carcinoma and hepatocellular carcinoma, and often involves the abdominal vasculature including the renal vein, portal vein, and the inferior vena cava. While a bland thrombus is composed of platelets and fibrin, in contrast, a tumor thrombus refers to an organized collection of tumor cells. Though oftentimes detected incidentally on imaging, tumor thrombus may have significant clinical implications and can be challenging to differentiate from bland thrombus. Additionally, the optimal management of tumor thrombus, including the use of anticoagulation, remains poorly described. This review summarizes common causes of tumor thrombus, as well as its impact on staging, prognosis, and treatment.
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Affiliation(s)
- Harsha Tathireddy
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
| | - Douglas Rice
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kylee Martens
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Joseph Shatzel
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, OR, USA
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Chen K, Liu Z, Li Y, Zhao X, Zhang Y, Bi H, Wang G, Liu C, Tian X, Zhang H, Ma L, Zhang S. Long-term outcomes after cytoreductive nephrectomy and thrombectomy of patients with metastatic renal cell carcinoma with venous tumor thrombus: a retrospective study from a large Chinese center. World J Surg Oncol 2023; 21:170. [PMID: 37280590 DOI: 10.1186/s12957-023-03048-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Targeted therapy combined with immunotherapy is the current first-line treatment for metastatic renal cell carcinoma (mRCC), but patients with tumor thrombus (TT) may suffer from lower limb edema or even sudden cardiac death, so the purpose of this study is to investigate the efficacy and safety of surgical treatment in patients with mRCC and TT and explore worse factors to affect the prognosis in this series of patients. PATIENTS AND METHODS A total of 85 mRCC patients with TT who received cytoreductive nephrectomy and thrombectomy at our medical center from 2014 to 2023 are included. All patients received postoperative systemic therapy. Overall survival (OS) is defined as the time from surgery to death due to any reason or the last follow-up. Kaplan-Meier analysis was performed to evaluate OS and differences among groups were tested by log-rank. Multivariable Cox proportional hazards analysis was performed to ascertain independent relationships between clinicopathological factors and OS. RESULTS The median age of patients was 58 years old. Eleven patients (12.9%) had no symptoms, 39 patients (45.9%) had local symptoms, 15 patients (17.6%) had systemic symptoms, and 20 patients (23.5%) had both. Mayo grade of TT was 0, 1, 2, 3, and 4 for 12, 27, 31, 7, and 8 patients respectively. Fifty-five patients had lung metastasis, 23 had bone metastasis, 16 had liver metastasis, 13 had adrenal metastasis, and 9 had lymph node metastasis. Of all patients, 17 patients had multiple metastases. The median operation time is 289 min and the median intraoperative hemorrhage is 800 ml. Twenty-eight patients experienced postoperative complications, 8 of which were serious complications of modified Clavien grade III or higher. The median OS of all patients was 33 months and median follow up time was 26 months. In multivariate analysis, systemic symptom (p = 0.00753), pathological type (p = 0.0166), sarcomatous degeneration (p = 0.0334), and perirenal fat infiltration (p = 0.0202) are independent predictors of OS. CONCLUSION Cytoreductive nephrectomy and thrombectomy is relatively safe and effective for patients with mRCC accompanied by TT. In this series of patients, the worse prognosis is associated with systemic symptoms, non-clear cell carcinoma, sarcomatous degeneration and perirenal fat infiltration.
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Affiliation(s)
- Kewei Chen
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | - Yuxuan Li
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | - Xun Zhao
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | - Yu Zhang
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | - Hai Bi
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China.
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