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Amparore D, Checcucci E, Piramide F, Busacca G, Volpi G, De Cillis S, Sica M, Verri P, Piana A, Di Dio M, Fiori C, Porpiglia F. Robotic Vena Cava Thrombectomy with Three-dimensional Augmented Reality Guidance. EUR UROL SUPPL 2024; 62:43-46. [PMID: 38434189 PMCID: PMC10909593 DOI: 10.1016/j.euros.2024.02.003] [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] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
Robotic surgery has recently been used for treatment of renal cell carcinoma (RCC) and neoplastic thrombus located in the renal vein or inferior vena cava (IVC). Accurate identification of the thrombus location is crucial, and three-dimensional augmented reality (3D AR) may be valuable in achieving this. We enrolled patients with nonmetastatic RCC and level 0-I venous thrombus (Mayo Clinic classification) for robot-assisted radical nephrectomy and thrombectomy with 3D AR guidance. Five patients were prospectively enrolled; three had a level 0 thrombus and two had a level I thrombus. The mean operative time was 123 ± 15 min, mean IVC clamping time was 9.4 ± 6.8 min, and mean estimated blood loss was 750 ± 150 ml. The AR system allowed precise estimation of the thrombus location in all cases. No intraoperative complications or postoperative Clavien-Dindo grade >2 complications occurred. Use of 3D AR guidance allowed correct estimation of the limits of the thrombus and guided the surgeon in selecting an appropriate surgical strategy.
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Affiliation(s)
- Daniele Amparore
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Federico Piramide
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Giovanni Busacca
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Gabriele Volpi
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Sabrina De Cillis
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Michele Sica
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Paolo Verri
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Michele Di Dio
- Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy
| | - Cristian Fiori
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
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Chen R, Mei Z, Chen J. Scrutinizing VTE risk factors in complex renal tumor patients: a comprehensive look at the VTE-RT-IVCTT study. Int J Surg 2024; 110:1813-1814. [PMID: 38051929 PMCID: PMC10942190 DOI: 10.1097/js9.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Ru Chen
- Department of Urology, Fujian Medical University Union Hospital, Gulou District, Fuzhou City, Fujian Province
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, People’s Republic of China
| | - Jianhui Chen
- Department of Urology, Fujian Medical University Union Hospital, Gulou District, Fuzhou City, Fujian Province
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Shah MS, Wang KR, Shah YB, Ragam R, Simhal RK, Ghodoussipour S, Djaladat H, Mark JR, Lallas CD, Chandrasekar T. A Narrative Review on Robotic Surgery as Treatment for Renal Cell Carcinoma with Inferior Vena Cava Thrombus. J Clin Med 2024; 13:1308. [PMID: 38592152 PMCID: PMC10932232 DOI: 10.3390/jcm13051308] [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: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Renal cell carcinoma (RCC) is a common diagnosis, of which a notable portion of patients present with an extension into the venous circulation causing an inferior vena cava (IVC) tumor thrombus. Venous extension has significant implications for staging and subsequent treatment planning, with recommendations for more aggressive surgical removal, although associated surgical morbidity and mortality is relatively increased. The methods for surgical removal of RCC with IVC thrombus remain complex, particularly surrounding the use of robot-assisted surgery. Robot assistance for radical nephrectomy in this context is recently emerging. Thrombus level has important implications for surgical technique and prognosis. Other preoperative considerations may include location, laterality, size, and wall invasion. The urology literature on treatment of such tumors is largely limited to case series and institutional studies that describe the feasibility of various surgical options for these complex tumors. Further understanding of the outcomes and patient-specific risk factors would shed increased light on the optimal treatment for such cases. This narrative review provides a thorough overview on the previously reported use of robot-assisted nephrectomy in RCC with IVC thrombus to inform further studies which may optimize outcomes and guide shared decision-making.
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Affiliation(s)
- Mihir S. Shah
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Kerith R. Wang
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Yash B. Shah
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Radhika Ragam
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | | | - Saum Ghodoussipour
- Division of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Houman Djaladat
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - James R. Mark
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
| | - Costas D. Lallas
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.S.S.)
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Li P, Tao Y, Zhao Y, Lyu X, Zhou X, Zhuo R, Ma L, Tao T, Zhou H. Robotic-assisted laparoscopic surgery for the treatment of Wilms' tumor in children: single-center experience and medium-term outcomes. J Robot Surg 2024; 18:3. [PMID: 38175361 DOI: 10.1007/s11701-023-01759-9] [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: 08/31/2023] [Accepted: 10/28/2023] [Indexed: 01/05/2024]
Abstract
To report our institutional experience and the medium-term outcomes of utilizing robotic-assisted laparoscopic surgery (RALS) in patients with Wilms' tumor (WT). The robotic surgical interventions include nephron-sparing surgery (RAL-NSS), radical nephrectomy (RAL-RN), and nephrectomy with inferior vena cava thrombectomy (RAL-N-IVCT). We retrospectively collected medical records of WT patients who underwent RALS in our center between August 2019 and February 2022. Patients' baseline demographics, preoperative parameters, and perioperative/postoperative data were recorded and analyzed. Follow-up results were collected to evaluate the oncological outcomes. A total of 12 patients (13 sides) with a median age of 30 (IQR: 19.5-45.5) months were included. All operations were successfully completed without conversion. Seven patients received preoperative chemotherapy. Distribution of surgical interventions was as follows: five patients underwent RAL-RN, five received RAL-NSS, one with bilateral WT underwent concurrent RAL-RN and RAL-NSS, and one received RAL-RN-IVCT post preoperative chemotherapy. Postoperative chemotherapy was conducted in ten patients. The estimated intraoperative blood loss was 27 ± 4.0 ml for the RAL-NSS group, 41.67 ± 12.13 ml for the RAL-RN group, and 350 ml for the RAL-RN-IVCT groups, respectively. The median perioperative serum creatinine levels were 32.5 (IQR: 30.75-39.5) μmol/l preoperatively and 35 (IQR: 31.75-38.5) μmol/l postoperatively, which showed no significant difference. No positive lymph nodes were detected. Postoperative chemotherapy was performed according to the tumor volume and pathological findings. The median follow-up time was 17.5 (15.8-22.3) months. During this interval, neither distant metastasis nor recurrence was identified. Based on our medium-term follow-up observations, RAL-NSS, RAL-RN, and RAL-RN-IVCT exhibit promising feasibility and safety profiles in the therapeutic landscape of WT.
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Affiliation(s)
- Pin Li
- Department of Urology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, People's Republic of China
- Department of Urology, Bayi Children's Hospital, Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, People's Republic of China
| | - Yuandong Tao
- Department of Urology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, People's Republic of China
- Department of Urology, Bayi Children's Hospital, Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, People's Republic of China
| | - Yang Zhao
- Department of Urology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, People's Republic of China
- Department of Urology, Bayi Children's Hospital, Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, People's Republic of China
- Medical School of Chinese PLA, Beijing, 100853, People's Republic of China
| | - Xuexue Lyu
- Department of Urology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, People's Republic of China
- Department of Urology, Bayi Children's Hospital, Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, People's Republic of China
- Medical School of Chinese PLA, Beijing, 100853, People's Republic of China
| | - Xiaoguang Zhou
- Department of Urology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, People's Republic of China
- Department of Urology, Bayi Children's Hospital, Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, People's Republic of China
| | - Ran Zhuo
- Department of Urology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, People's Republic of China
- Department of Urology, Bayi Children's Hospital, Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, People's Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Lifei Ma
- Department of Urology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, People's Republic of China
- Department of Urology, Bayi Children's Hospital, Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, People's Republic of China
| | - Tian Tao
- Department of Urology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, People's Republic of China
- Department of Urology, Bayi Children's Hospital, Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, People's Republic of China
| | - Huixia Zhou
- Department of Urology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, People's Republic of China.
- Department of Urology, Bayi Children's Hospital, Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, People's Republic of China.
- Medical School of Chinese PLA, Beijing, 100853, People's Republic of China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China.
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Zhao J, Ding X, Peng C, Tian X, Wang M, Fu Y, Guo H, Bai X, Zhai X, Huang Q, Liu K, Li L, Ye H, Zhang X, Ma X, Wang H. Assessment of Ki-67 proliferation index in prognosis prediction in patients with nonmetastatic clear cell renal cell carcinoma and tumor thrombus. Urol Oncol 2024; 42:23.e5-23.e13. [PMID: 38030468 DOI: 10.1016/j.urolonc.2023.11.001] [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: 08/21/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE To determine the optimal cut-off value of Ki-67 for predicting the survival of patients with clear cell renal cell carcinoma (ccRCC) and tumor thrombus and to explore the correlation between Ki-67 expression and pathological features. PATIENTS AND METHODS We retrospectively analyzed Ki-67 immunohistochemical staining of ccRCC and tumor thrombus resected from February 2006 to February 2022. The survival rate was evaluated using the Kaplan-Meier method. The optimal cut-off value of the Ki-67 expression for predicting survival was determined by the minimum P-value method. Clinicopathological data were compared based on Ki-67 status (low versus high expression). Univariate and multivariate Cox regression analysis was used to explore independent predictors. RESULTS A total of 202 patients (median age, 58 years [IQR, 52-65 years], 147 men) with ccRCC and tumor thrombus were included in the study. The optimal cut-off value of Ki-67 for predicting survival was 30%. 159 (78.7%) and 43 (21.3%) patients were included in the low-expression and high-expression groups. Patients with Ki-67 high expression had significantly worse recurrence-free survival (P < 0.001) and cancer-specific survival (P < 0.001). Ki-67 high expression was associated with adverse pathological features, including tumor necrosis, ISUP nuclear grade, sarcomatoid differentiation, perirenal fat invasion, renal pelvis invasion, and inferior vena cava wall invasion (all P < 0.050). Ki-67 expression ≥ 30% (P = 0.016), tumor side (P = 0.003), diabetes (P = 0.040), blood loss (P = 0.016), inferior vena cava wall invasion (P = 0.016), and sarcomatoid differentiation (P = 0.014) were independent predictors of cancer-specific survival. CONCLUSION The optimal cut-off level of Ki-67 in predicting the prognosis of ccRCC and tumor thrombus was 30%. The high expression of Ki-67 was associated with the aggressive pathological phenotype and poor prognosis.
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Affiliation(s)
- Jian Zhao
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, PR China; Department of Radiology, Armed Police Force Hospital of Sichuan, Leshan, PR China
| | - Xiaohui Ding
- Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Cheng Peng
- Department of Urology, Chinese PLA General Hospital, Beijing, PR China
| | - Xia Tian
- Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Meifeng Wang
- Department of Radiology, Sixth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Yonggui Fu
- Department of Radiology, Sixth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Huiping Guo
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, PR China
| | - Xu Bai
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, PR China
| | - Xue Zhai
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, PR China
| | - Qingbo Huang
- Department of Urology, Chinese PLA General Hospital, Beijing, PR China
| | - Kan Liu
- Department of Urology, Chinese PLA General Hospital, Beijing, PR China
| | - Lin Li
- Department of Innovative Medical Research, Hospital Management Institute, Chinese PLA General Hospital, Beijing, PR China
| | - Huiyi Ye
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, PR China
| | - Xu Zhang
- Department of Urology, Chinese PLA General Hospital, Beijing, PR China
| | - Xin Ma
- Department of Urology, Chinese PLA General Hospital, Beijing, PR China
| | - Haiyi Wang
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, PR China.
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Hatzakorzian R, Blotsky A, Moore A, Vaillancourt J, Mettasittigorn P, Aprikian A, Backman SB. Migration of an Inferior Vena Cava Tumor Thrombus during Renal Cell Carcinoma Resection. Case Rep Anesthesiol 2023; 2023:6632030. [PMID: 38170091 PMCID: PMC10761220 DOI: 10.1155/2023/6632030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/21/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
Approximately 4%-10% of patients with renal cell carcinoma (RCC) have tumoral vascular invasion with resultant thrombi in the renal vein and in the inferior vena cava (IVC). The authors describe an interesting case of IVC tumor thrombus that migrated to the right cardiac chambers during RCC resection. The diagnosis was made by intraoperative transesophageal echocardiography (TEE), which revealed the presence of a free-floating thrombus between the right atrium (RA) and right ventricle (RV). The patient required an urgent sternotomy with cardiopulmonary bypass (CPB) for atrial thrombus removal prior to the completion of the nephrectomy. The patient made a full recovery and was discharged to a rehabilitation facility. These findings illustrate the importance of intraoperative TEE monitoring during nephrectomy and IVC thrombectomy. In this case, TEE allowed for the diagnosis of an unexpected complication necessitating prompt cardiac surgical management.
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Affiliation(s)
- Roupen Hatzakorzian
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
- Department of Critical Care, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Andrea Blotsky
- Department of Critical Care, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
- Department of General Internal Medicine, McGill University, St-Mary's Hospital, 3830 Lacombe Avenue, Montréal H3T 1M5, Québec, Canada
| | - Albert Moore
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Julien Vaillancourt
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Pattra Mettasittigorn
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Armen Aprikian
- Department of Urology, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
| | - Steven B. Backman
- Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada
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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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Zhou S, Zheng J, Zhai W, Chen Y. Spatio-temporal heterogeneity in cancer evolution and tumor microenvironment of renal cell carcinoma with tumor thrombus. Cancer Lett 2023; 572:216350. [PMID: 37574183 DOI: 10.1016/j.canlet.2023.216350] [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: 06/12/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
Metastasis is the most fatal aspect of cancer, often preceded by a tumor thrombus (TT) which forms within the vascular system. Renal cell carcinoma (RCC), the predominant form of kidney cancer, witnesses a venous system invasion in 4-10% of cases, resulting in venous tumor thrombus (RCC-TT). This variant represents a formidable clinical challenge due to its escalated surgical complexity, heightened risk of progression and metastasis, and an adverse prognosis. However, recent trials addressing RCC-TT face significant barriers stemming from the profound inter- and intra-tumoral heterogeneity, patient-specific treatment variations, and distinct therapeutic resistance patterns between the primary tumor (PT) and the TT. This review delves into the unique evolutionary pathway of RCC-TT, the relationship between the staging and grading of RCC-TT invasion patterns, and the spatial molecular profiling of RCC-TT. Additionally, we assess the temporal heterogeneity among TT, PT, and distant metastases, as well as the functional phenotypes of TME components. An outlook for future research on RCC-TT is also provided.
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Affiliation(s)
- Sian Zhou
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Junhua Zheng
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Wei Zhai
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China; Department of Urology, State Key Laboratory of Oncogenes and Related Genes, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
| | - Yonghui Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
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9
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Wang T, Peng C, Ding X, Yang Y, Li J, Gu L, Wang B, Ma X. Renal angiomyolipoma with tumor thrombi: Clinical analysis of 18 cases in a single-center experience. Urol Oncol 2023; 41:328.e1-328.e8. [PMID: 37149431 DOI: 10.1016/j.urolonc.2023.04.007] [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: 11/19/2022] [Revised: 02/03/2023] [Accepted: 04/04/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To improve understanding of the clinical features of renal angiomyolipoma (AML) accompanied by tumor thrombus (TT). METHODS From January 2017 to February 2022, 18 patients with AML and TT were enrolled. We retrospectively analyzed them and there were 6 cases of epithelial AML (EAML) and 12 of classical AML (CAML). We compared the key variables between the two cohorts. RESULTS The mean age of the 18 cases was 42.0 (standard deviation [SD] 13.4) years and 14 (77.8%) were female. Eleven (61.1%) tumors were on the right side. Only two (11.1%) cases presented with flank pain. The mean follow-up time was 33.6 (IQR: 20.1-48.5) months. All participants were alive at the end of follow-up. One case developed lung metastases 21 months after operation but entered remission after 2 years of everolimus treatment. The imaging diagnoses of all CAML cases were consistent with the pathology, while all imaged EAML cases were diagnosed with carcinomas. Five EAML cases, but only one CAML case, exhibited necrosis (83.3 vs. 8.3%, P = 0.001). The Ki-67 index of the EAML group was significantly higher than that of the CAML group (7 vs. 2, P = 0.004). CONCLUSIONS Compared to CAML, EAML tended to be associated with a higher imaging misdiagnosis rate, and was more commonly associated with necrosis and a higher Ki-67 index. Surgery remains the prime treatment for nonmetastatic AML with TT; such cases have a relatively good prognosis despite the malignant potential.
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Affiliation(s)
- Tao Wang
- Department of Urology, the third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Cheng Peng
- Department of Urology, the third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xiaohui Ding
- Department of Pathology, the first Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yang Yang
- Department of Urology, the third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jinhang Li
- Department of Pathology, the first Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Liangyou Gu
- Department of Urology, the third Medical Centre, Chinese PLA General Hospital, Beijing, China.
| | - Baojun Wang
- Department of Urology, the third Medical Centre, Chinese PLA General Hospital, Beijing, China.
| | - Xin Ma
- Department of Urology, the third Medical Centre, Chinese PLA General Hospital, Beijing, China.
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10
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Zhang Y, Bi H, Fu Y, Zhang H, Zhang S, Liu K, Liu L, Li N, Liu C, Tian X, Ma L. Cephalic inferior vena cava non-clamping technique versus standard procedure for robot-assisted laparoscopic level II-III thrombectomy: a prospective cohort study. Int J Surg 2023; 109:1594-1602. [PMID: 37131326 PMCID: PMC10389522 DOI: 10.1097/js9.0000000000000209] [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: 08/01/2022] [Accepted: 01/03/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Renal tumour can invade the venous system and ~4-10% patients with renal tumour had venous thrombus. Although the feasibility of robot-assisted laparoscopic inferior vena cava thrombectomy (RAL-IVCT) in patients with inferior vena cava (IVC) thrombus has been validated, the wide application is still a challenge due to the complexity of IVC control. The objective was to describe our novel cephalic IVC non-clamping technique and to compare the outcomes versus standard RAL-IVCT. MATERIALS AND METHODS A prospective single-centre cohort containing 30 patients with level II-III IVC thrombus was established since August 2020. Fifteen patients underwent cephalic IVC non-clamping approach and 15 patients received standard RAL-IVCT. The authors decided the surgical technique according to the echocardiographic assessment of the right heart and IVC. RESULTS The non-clamping group had less operative time (median 148 versus 185 min, P =0.04), and lower Clavien-grade II complication rate (26.7% versus 80.0%, P =0.003). The median intraoperative blood loss were 400 ml [interquartile range (IQR) 275-615 mL] and 800 ml (IQR 350-1300 ml), respectively ( P =0.05). The most common complication in standard RAL-IVCT group was liver dysfunction. No gas embolism, hypercapnia or tumour thrombus dislodgment occurred in non-clamping group. After a median follow-up of 17.0 months (IQR 13.5-18.5 months) and 15.5 months (IQR 13.0-17.0 months), two patients (16.7%) in the non-clamping group and 3 patients (20.0%) in the standard RAL-IVCT group died (hazard ratio 0.59, 95% CI 0.10-3.54, P =0.55). CONCLUSIONS The cephalic IVC non-clamping technique can be performed safely with acceptable surgical outcomes and short-term oncologic outcomes in patients with level II-III IVC thrombus. Compared with standard procedure, it had less operative time and lower complication rate.
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Affiliation(s)
| | | | - YunJie Fu
- School of Basic Medical Sciences, Peking University, Beijing, China
| | | | | | | | | | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital
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Wu Z, Wu Y, Liu Z, Song Y, Ge L, Du T, Liu Y, Liu L, Liu C, Ma L. L1CAM deployed perivascular tumor niche promotes vessel wall invasion of tumor thrombus and metastasis of renal cell carcinoma. Cell Death Discov 2023; 9:112. [PMID: 37015905 PMCID: PMC10073121 DOI: 10.1038/s41420-023-01410-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/06/2023] Open
Abstract
The survival of tumor cells in the bloodstream, and vasculature adhesion at metastatic sites are crucial for tumor metastasis. Perivascular invasion aids tumor cell self-renewal, survival, and formation of metastases by facilitating readily available oxygen, nutrients, and endothelial-derived paracrine factors. Renal cell carcinoma (RCC) is among the most prevalent tumors of the urinary system, and the formation of venous tumor thrombus (VTT) is a characteristic feature of RCC. We observed high expression of L1CAM in the VTT with vessel wall invasion. L1CAM promotes the adhesion, migration, and invasion ability of RCC and enhances metastasis by interacting with ITGA5, which elicits activation of signaling downstream of integrin α5β1. L1CAM promotes ADAM17 transcription to facilitate transmembrane ectodomain cleavage and release of soluble L1CAM. In response to soluble L1CAM, vascular endothelial cells release several cytokines and chemokines. Endothelial-derived CXCL5 and its receptor CXCR2 promote the migration and intravasation of RCC toward endothelial cells suggesting that crosstalk between endothelial cells and tumor cells has a direct guiding role in driving the metastatic spread of RCC. LICAM plays a crucial role in the invasive ability of RCC, and regulation of L1CAM expression may contribute therapeutically to preventing RCC progression.
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Affiliation(s)
- Zonglong Wu
- Department of Urology, Peking University Third Hospital, Beijing, 100191, P.R. China
| | - Yaqian Wu
- 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
| | - Yimeng Song
- Department of Urology, Peking University Third Hospital, Beijing, 100191, P.R. China
| | - Liyuan Ge
- Department of Urology, Peking University Third Hospital, Beijing, 100191, P.R. China
| | - Tan Du
- Department of Urology, Peking University Third Hospital, Beijing, 100191, P.R. China
| | - Yunchong Liu
- Department of Urology, Peking University Third Hospital, Beijing, 100191, P.R. China
| | - Li Liu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, 100191, P.R. China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, Beijing, 100191, P.R. China.
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, P.R. China.
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, 100191, P.R. China.
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Zhang JH, Zeinab MA, Ferguson EL, Beksac AT, Schwen ZR, Aminsharifi A, Eltemamy M, Kaouk J. Minimally-Invasive Radical Nephrectomy and Left-Sided Level II Caval Thrombectomy: A New Combined Technique. Urology 2023; 172:220-223. [PMID: 36436673 DOI: 10.1016/j.urology.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/22/2022] [Accepted: 10/02/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To present a combined multiport robotic and open approach for left radical nephrectomy and inferior vena cava thrombectomy in patients with a primary left renal mass and level II inferior vena cava (IVC) tumor thrombus. METHODS A 69-year-old female was diagnosed with an 8.9cm left renal neoplasm with level II IVC thrombus. She was placed in the left-side-up flank position. The descending colon was mobilized and the left gonadal vein was identified. The left renal vein was identified and fully dissected. The left renal artery was dissected and stapled. The kidney was dissected and left detached with exception of the renal vein. The robot was undocked and the patient was positioned supine. Through a supra-umbilical midline incision, the ascending colon and duodenum were mobilized medially. The right renal vein and IVC were identified and dissected to the level of hepatic veins. The IVC was clamped using a Satinsky clamp. The right renal artery and vein remained patent during thrombectomy. The IVC was opened, the thrombus was evacuated, and IVC was closed. Clamps were removed and the kidney was removed. RESULTS Operative time was 405 minutes. IVC clamp time was 14 minutes. Estimated blood loss was 500cc. Recovery was uncomplicated. Length of stay was 4 days. Pathology showed clear cell carcinoma with negative margins. CONCLUSION IVC thrombectomy is challenging on left sided tumors. Combining a robotic and open technique together is feasible and allows a smaller supra-umbilical midline incision compared to standard open incision.
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Affiliation(s)
- Jj H Zhang
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Ethan L Ferguson
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Alp Tuna Beksac
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Zeyad R Schwen
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Mohamed Eltemamy
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Olivero A, Liu K, Checchucci E, Liu L, Ma L, Wang G, Mantica G, Tappero S, Amparore D, Sica M, Fiori C, Huang Q, Niu S, Wang B, Ma X, Hou X, Porpiglia F, Terrone C, Zhang X. Adrenocortical carcinoma with venous tumor invasion: is there a role for mini-invasive surgery? Langenbecks Arch Surg 2023; 408:17. [PMID: 36625975 DOI: 10.1007/s00423-023-02765-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 11/22/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study aims to investigate early oncologic outcomes in patients with adrenocortical carcinoma (ACC) with venous invasion (VI) treated using both open and mini-invasive approaches. PATIENTS AND MATERIALS We conducted a retrospective analysis of 4 international referral center databases, including all the patients undergoing adrenalectomy for ACC with VI from January 2007 to March 2020. According to CT scan or MRI, the tumor thrombus was classified into four levels: (1) adrenal vein invasion; (2) renal vein invasion; (3) infra-hepatic Inferior vena cava (IVC); and (4) retro-hepatic IVC. In addition, we divided our patients into patients who had undergone open surgery and mini-invasive surgery. RESULTS We identified 20 patients with a median follow-up of 12 months. The median tumor size was 110mm. ENSAT stage was II in 4 patients, III in 13 patients, and IV in 3 patients. Tumor thrombus extended in the adrenal vein (n=5), renal vein (n=1), infra-hepatic IVC (n=9), or into the retro-hepatic IVC (n=5). Ten patients were treated with a mini-invasive approach. The patient treated with an open approach reported a more aggressive disease. The two groups did not differ in surgical margins, surgical time, blood losses, complications, and length of stay. The prognosis resulted worse in the patient undergoing open. Kaplan-Meier analysis indicated a difference in OS for the patients stratified by ENSAT stage (Log-rank p=0.011); we also reported a difference in DFS for patients stratified for thrombus extension (p=0.004) and ENSAT stage (p<0.001). CONCLUSION The DFS of patients with VI from ACC is influenced by the staging and the extension of the venous invasion; the staging influences the OS. The mini-invasive approach seems feasible in selected patients; however, further studies investigating the oncological outcomes are needed. A mini-invasive approach for adrenal tumors with venous invasion is an explorable option in very selected patients.
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Affiliation(s)
- Alberto Olivero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy.
| | - Kan Liu
- Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Enrico Checchucci
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Lei Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Stefano Tappero
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Michele Sica
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Quingbo Huang
- Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Shaoxi Niu
- Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Baojun Wang
- Department of Urology, Chinese PLA General Hospital, Beijing, China.
| | - Xin Ma
- Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Xiaofei Hou
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Xu Zhang
- Department of Urology, Chinese PLA General Hospital, Beijing, China
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Dhanji S, Wang L, Liu F, Meagher MF, Saidian A, Derweesh IH. Recent Advances in the Management of Localized and Locally Advanced Renal Cell Carcinoma: A Narrative Review. Res Rep Urol 2023; 15:99-108. [PMID: 36879830 PMCID: PMC9985462 DOI: 10.2147/rru.s326987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/28/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose To review the current status of surgical and procedural treatments for renal cell carcinoma (RCC), focusing on oncological and functional outcomes, and the use of techniques for advanced disease over the last 10 years. Findings Partial nephrectomy (PN) has become the reference standard for most T1 and T2 masses. In cT2 RCC, PN exhibits oncological equivalence and improved functional outcomes compared to radical nephrectomy (RN). Additionally, emerging data suggest that PN may be used to treat cT3a RCC. The robot-assisted platform is increasingly used to treat locally advanced RCC. Studies suggest safety and feasibility of robotic RN and robotic inferior vena cava tumor thrombectomy. Additionally, single-port robot-assisted laparoscopic approaches are comparable to multiport approaches in select patients. Long-term data show that cryoablation, radiofrequency ablation, and microwave ablation are equipotent in management of small renal masses. Emerging data suggest that microwave may effectively treat cT1b masses.
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Affiliation(s)
- Sohail Dhanji
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Luke Wang
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Franklin Liu
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Margaret F Meagher
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ava Saidian
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ithaar H Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
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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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Li HP, Wang XR, Zhang M, Zhang XX. Modified left robot-assisted radical nephrectomy combined with level Ⅰ inferior vena cava thrombectomy: A case report and lesson. Asian J Surg 2022:S1015-9584(22)01707-9. [DOI: 10.1016/j.asjsur.2022.11.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
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17
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Liu Z, Li Y, Tang S, Zhao X, Chen K, Ge L, Zhu G, Hong P, Wu B, Wu Z, Zhang S, Tian X, Wang S, Liu C, Zhang H, Ma L. Preliminary experience of oblique occlusion technique in robot-assisted infrahepatic inferior vena cava thrombectomy: step-by-step procedures and short term outcomes. BMC Surg 2022; 22:377. [PMCID: PMC9636754 DOI: 10.1186/s12893-022-01821-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
We aimed to compare the oncological outcomes between the oblique occlusion technique and the traditional technique for robot-assisted radical nephrectomy (RARN) with inferior vena cava (IVC) thrombectomy, and to explore the safety and effectiveness of the oblique occlusion technique.
Methods
Overall, 21 patients with renal cell carcinoma (RCC) and IVC tumor thrombus (TT) were admitted to our hospital from August 2019 to June 2020. All the patients underwent RARN with IVC thrombectomy, of which the IVC oblique occlusion technique was used in 11 patients and traditional occlusion technique was used in 10 patients. The oblique occlusion technique refers to oblique blocking from the upper corner of the right renal vein to the lower corner of the left renal vein using a vessel tourniquet or a vessel clamp (left RCC with IVCTT as an example).
Results
Compared with patients in the traditional group, those in the oblique group had lower serum creatinine at follow-up (3 month) (95 ± 21.1 vs. 131 ± 30.7 μmol/L, P = 0.03). There was no significant difference in operation time [149 (IQR 143–245) min vs. 148 (IQR 108–261) min, p = 0.86], IVC clamping time [18 (IQR 12–20) min vs. 20 (IQR 14–23) min, p = 0.41], and estimated intraoperative blood loss [300 (IQR 100–800) mL vs. 500 (IQR 175–738) mL, p = 0.51] between both groups. During a 16-month (range, 15–23 months) follow-up period, two cases progressed in the oblique group and three cases progressed in the traditional group.
Conclusions
The modified IVC oblique occlusion technique procedure is relatively safe and effective in RARN with IVC thrombectomy. The IVC oblique occlusion technique may play a role in the protection of renal function.
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Zhang W, Bao K, Zheng L, Cai L, Yan B, Yang R. A robotic puncture system with optical and mechanical feedback under respiratory motion. Int J Med Robot 2022; 18:e2403. [PMID: 35384266 DOI: 10.1002/rcs.2403] [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] [Received: 02/16/2022] [Revised: 04/02/2022] [Accepted: 04/03/2022] [Indexed: 12/24/2022]
Abstract
Puncture robot can improve the accuracy and efficiency of puncture surgery, such as thoracoabdominal and liver puncture. However, as soft tissue is deformed and shifted under respiratory motion and during the puncture process, the needle is pulled, resulting in the needle's bending and deformation, which increases the risks and sufferings of the patient, a robotic puncture system with optical and mechanical feedback is necessary. Therefore, this paper proposes a multi-information sensing 'guide-clamp' end effector for puncture surgery to accurately detect the posture and force on the puncture needle in real time. And gravity bias method with trajectory planning and the compensational controlling model are also proposed to offset the interference of self-weight and achieve zero force following. This system is evaluated by the experiments of robot controlling and human tissue simulation and the results prove the excellent robustness of the system, which meet the clinical requirement.
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Affiliation(s)
- Wenlong Zhang
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Kaiyang Bao
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Lingxiang Zheng
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Lijing Cai
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Biao Yan
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Rongqian Yang
- School of Electronic and Information Engineering, South China University of Technology, Guangzhou, China
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Wang K, Liu Z, Hong P, Qin YC, Zhao X, Zhang HX, Liu C, Ge LY, Ma LL. T.H.R.O.B.V.S. Score – A Comprehensive Model to Predict the Surgical Complexity of Renal Cell Carcinoma With Tumor Thrombus. Front Oncol 2022; 12:900550. [PMID: 35814463 PMCID: PMC9261335 DOI: 10.3389/fonc.2022.900550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background To propose a quantitative model for predicting the surgical complexity of patients with renal cell carcinoma (RCC) and venous tumor thrombus (VTT). Method The clinical data of 226 cases of RCC with VTT in Peking University Third Hospital from January 2014 to August 2020 were retrospectively analyzed. Seven indicators were selected to establish the T.H.R.O.B.V.S. system, including alkaline phosphatase, tumor thrombus height, maximum tumor diameter, obesity, bland thrombus, vascular wall invasion, and side. Each indicator was assigned with 0, (1), and 2 points, and the total scores of 0~2, 3~5, and ≥6 were set as the low-, middle-, and high-risk groups, respectively. The surgical complexity was compared and validated among groups. Results As the risk increased, the proportion of open surgery significantly increased (P<0.001). The operation time (P<0.001), intraoperative blood loss (P<0.001), blood or plasma transfusion (P<0.001), and hospitalization (P<0.001) increased significantly. The postoperative complications (P<0.001), including notable complications (≥Clavein-Dindo II, P<0.001), were significantly different, and similar trends were shown in the validation group. Conclusion The T.H.R.O.B.V.S. scoring system is a quantifiable and satisfactory model to predict the surgical complexity and perioperative management of RCC with VTT.
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Affiliation(s)
| | | | | | | | | | | | | | - Li-yuan Ge
- *Correspondence: Lu-lin Ma, ; Li-yuan Ge,
| | - Lu-lin Ma
- *Correspondence: Lu-lin Ma, ; Li-yuan Ge,
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Baheen Q, Liu Z, Hao Y, Sawh RRR, Li Y, Zhao X, Hong P, Wu Z, Ma L. The Significant Role of Tumor Volume on the Surgical Approach Choice, Surgical Complexity, and Postoperative Complications in Renal Cell Carcinoma With Venous Tumor Thrombus From a Large Chinese Center Experience. Front Oncol 2022; 12:869891. [PMID: 35747828 PMCID: PMC9209712 DOI: 10.3389/fonc.2022.869891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/29/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To explore the role of tumor volume (TV) on surgical approach choice, surgical complexity, and postoperative complications in patients with renal cell carcinoma (RCC) and inferior vena cava tumor thrombus. Method From January 2014 to January 2020, we retrospectively analyzed the clinical data of 132 patients who underwent radical nephrectomy with inferior vena cava thrombectomy (RN-IVCT). Primary renal tumor volume (PRTV), renal vein tumor thrombus volume (RVTTV), inferior vena cava tumor thrombus volume (IVCTTV), and total tumor thrombus volume (TTTV) were measured with the help of an internationally recognized 3D volume measurement software. The patients were divided into three groups according to the tumor volume within the inferior vena cava (IVC). Group 1 included 48 patients with IVCTTV between 0 and 15 cm3 (36.6%), group 2 included 38 patients with IVCTTV between 16 and 30 cm3 (28%), and group 3 included 46 patients with IVCTTV above 30 cm3 (35%). The three IVCTTV groups, as well as four different volume groups, were compared in terms of surgical approach choice, surgical complexity, and postoperative complications. One-way ANOVA and a non-parametric test were used to compare the clinicopathological characteristics and distribution differences between the three groups. Result This study found significant differences among the three groups in the proportion of open surgery (P < 0.001), operation time (P < 0.044), intraoperative bleeding (P < 0.001), and postoperative complications (P < 0.001). When the four different volumes were compared, we found that for higher volumes IVCTTV and TTTV, open surgery is used more often compared with laparoscopic surgery (P < 0.001). In addition, with the increase in renal vein tumor thrombus volume, inferior vena cava tumor thrombus volume, and total tumor thrombus volume, the operation time also increased. Finally, with the increase in tumor thrombus volume and total tumor thrombus volume, the amount of intraoperative bleeding increased. Conclusion With the increase in tumor volume, the proportion of open surgery and the incidence of postoperative complications increased. In addition, larger tumor volume prolongs operation time, increases intraoperative blood loss, and makes the surgery more complicated.
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Ai Q, Chen C, Yu Y, Wu S, Huang Q, Li X, Wang H, Li Q, Zhang X, Ma X, Wang B. Progressive Obstruction of Inferior Vena Cava by Ameroid Constrictor: The Canine Model of Revealing Hemodynamic and Compensatory Patterns of Tumor Thrombus Formation at The Renal Hilus Level. J Endourol 2022; 36:1119-1125. [PMID: 35651277 DOI: 10.1089/end.2021.0760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To develop an efficient and stable canine model of IVC progressive obstruction at the renal hilus level. METHODS The model was established in two beagles by encircling an ameroid constrictor on the IVC at renal hilus level. Abdominal wall varicosity and animal weight variations were observed weekly after operation. Ultrasound examination was performed weekly after surgery to observe the AC position, the diameter and the velocity in the IVC. Six weeks after surgery, IVC angiography and CT scan were performed to observe the collateral circulation establishment and internal organ variation. Blood samples were taken regularly to monitor for variation in critical biochemical parameters. Renal biopsy was performed at 0, 2, 4, and 6 weeks after surgery. RESULTS Superficial varicose veins were observed on the abdominal wall at 2 weeks after surgery. Four weeks after operation, the IVC diameter increased by approximately 30%, whereas the IVC velocity decreased by more than 50%. Collateral circulation was observed by IVC angiography at 6 weeks through multiple dilated veins along with neovascularization. CT scan showed congestive alteration in the kidney. The body weight, kidney, and liver function were not significantly affected. Chronic congestive renal injury was detected in the renal tubular epithelium by kidney biopsy after surgery. CONCLUSIONS A canine model of IVC progressive obstruction at renal hilus level was stably and safely established for the first time by using an AC, which may be helpful for preserving pivotal collateral circulation and non-tumor side kidney function in the IVC thrombus surgery.
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Affiliation(s)
- Qing Ai
- Chinese PLA General Hospital, 104607, Department of Urology, the Third Medical Centre, Beijing, Beijing, China;
| | - Changyu Chen
- Chinese PLA General Hospital, 104607, Department of Urology, the Third Medical Centre, Beijing, Beijing, China;
| | - Yao Yu
- Chinese PLA General Hospital, 104607, Department of Urology, the Third Medical Centre, Beijing, Beijing, China;
| | - Shengpan Wu
- Chinese PLA General Hospital, 104607, Department of Urology, the Third Medical Centre, Beijing, Beijing, China;
| | - Qingbo Huang
- Chinese PLA General Hospital, 104607, Department of Urology, the Third Medical Centre, Beijing, Beijing, China;
| | - Xin Li
- Chinese PLA General Hospital, 104607, Department of Radiology, the First Medical Centre, Beijing, Beijing, China;
| | - Haiyi Wang
- Chinese PLA General Hospital, 104607, Department of Radiology, the First Medical Centre, Beijing, Beijing, China;
| | - Qiuyang Li
- Chinese PLA General Hospital, 104607, Department of Ultrasonography, the First Medical Centre, Beijing, Beijing, China;
| | - Xu Zhang
- Chinese PLA General Hospital, 104607, Department of Urology, the Third Medical Centre, Beijing, Beijing, China;
| | - Xin Ma
- Chinese PLA General Hospital, 104607, Department of Urology, the Third Medical Centre, Beijing, Beijing, China;
| | - Baojun Wang
- Chinese PLA General Hospital, 104607, Department of Urology, the Third Medical Centre, Beijing, China;
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Zhao GD, Zhang XP, Hu MG, Huang QB, Xu S, Wang BJ, Ma X, Zhang X, Zou WB, Zhang X, Zhao ZM, Tan XL, Chou S, Wang G, Liu R. Step-by-step and orderly lowering of the height of inferior vena cava tumor thrombus is the key to robot-assisted thrombectomy for Mayo III/IV tumor thrombus. BMC Cancer 2022; 22:151. [PMID: 35130848 PMCID: PMC8822687 DOI: 10.1186/s12885-022-09235-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/12/2022] [Indexed: 11/14/2022] Open
Abstract
Background The surgical management of Mayo III/IV tumor thrombi is difficult and risky, and robotic surgery is even more difficult. The purpose of this study was to introduce the step-by-step and orderly lowering of the height of inferior vena cava tumor thrombus, which was the core technique of robot operation for Mayo III/IV tumor thrombus. Method A total of 18 patients were included in this study. The average tumor thrombus height was 2.4 cm above the level of the second porta hepatis (SPH), and 9 patients were prepared for cardiopulmonary bypass (CPB) before surgery. During the operation, the height of the tumor thrombus was lowered orderly for 2-3 times, and the blood flow blocking method was changed sequentially. The CPB was required when tumor thrombus in the atrium; After the height of the thrombus was lowered to the atrium entrance, CPB was stopped and the blood flow was blocked in the upper- and retro-hepatic inferior vena cava (IVC); After the tumor thrombus continued to descend to the lower part of the SPH, liver blood flow could be restored, and then, the blood flow was simply blocked in the retro-hepatic IVC to complete the removal of the thrombus and the repair or resection of the IVC. Finally, the diseased kidney and renal vein were removed. Results All operations were successfully completed, and 2 cases were transferred to laparotomy. Seven cases received CPB, while the other 11 did not. 15 patients underwent two times of the lowering of the tumor thrombus, 2 patients underwent one time and 1 patient underwent three times. The mean liver/IVC dissociation and vascular suspension time was 22.0 min. All patients had less than Clavien-Dindo grade III complications, no serious complications occurred during operation, and no patient died within 90 days. Conclusions The step-by-step and orderly decline of tumor thrombus height is the key to the success of robot Mayo III / IV tumor thrombus surgery. This method can shorten FPH and CPB time and improve the success rate of surgery.
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Affiliation(s)
- Guo-Dong Zhao
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Xiu-Ping Zhang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Ming-Gen Hu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Qing-Bao Huang
- Faculty of Urology Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Shuai Xu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China.,School of Medicine, Nankai University, Tianjin, China
| | - Bao-Jun Wang
- Faculty of Urology Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xin Ma
- Faculty of Urology Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xu Zhang
- Faculty of Urology Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Wen-Bo Zou
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Xuan Zhang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Zhi-Ming Zhao
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Xiang-Long Tan
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Sai Chou
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Gang Wang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Rong Liu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China. .,School of Medicine, Nankai University, Tianjin, China.
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23
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Surgical treatment of renal cell carcinoma with inferior vena cava tumor thrombus. Surg Today 2022; 52:1125-1133. [PMID: 34977987 DOI: 10.1007/s00595-021-02429-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The present report discusses the indications of cardiopulmonary bypass (CPB) in open nephrectomy and surgical outcomes of conventional and minimally invasive surgical techniques for treating advanced renal cell carcinoma with inferior vena cava tumor thrombus. METHODS The present study involved a comprehensive retrieval of pertinent literature from the most recent two decades. RESULTS Comparisons between radical nephrectomy procedures in terms of open, laparoscopic and robotic-assisted surgeries revealed that open surgery had more blood loss, a longer operation time and higher mortality rates than laparoscopic and robotic-assisted surgeries. Furthermore, surgery with CPB was associated with more blood loss than non-CPB surgery. Rates of early and late deaths were much higher in patients with CPB than in those without CPB. CONCLUSIONS Different surgical techniques had different indications in terms of levels of inferior vena cava tumor thrombus. The laparoscopic, robotic-assisted, open surgical techniques and CPB with deep hypothermic circulatory arrest were indicated for Levels I, II, III and III-IV inferior vena cava tumor thrombus, respectively. Laparoscopic and robotic-assisted surgeries cause less trauma than open surgery but require more complicated equipments to support the procedure. CPB should be avoided in radical nephrectomy whenever possible. The increased application of laparoscopic and robotic techniques in the future is anticipated.
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24
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Ma J, Sun W, Qian W, Min J, Zhang T, Yu D. Modified vein clamping technique for renal cell carcinoma complicated with level I-II IVC thrombi: a study at a single centre. BMC Urol 2021; 21:179. [PMID: 34933681 PMCID: PMC8691095 DOI: 10.1186/s12894-021-00947-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives To share our initial experience with the modified vein clamping technique for the treatment of renal cell carcinoma complicated with level I–II IVC thrombi. Methods From March 2018 to April 2021, 11 patients with renal cell carcinoma (RCC) involving an IVC tumour thrombus were admitted to our hospital. They all underwent laparoscopic radical nephrectomy and IVC thrombectomy (LRN-IVCTE) using a modified vein clamping technique. Results All procedures were successfully completed without conversion to open surgery. The median operative time was 185.00 min (145.00–216.00 min); the median estimated blood loss was 200.00 ml (155.00–300.00 ml), and four patients received an intraoperative transfusion. In addition, the median IVC clamping time was 18.00 min (12.00–20.00 min); the median postoperative hospital stay was 6.00 days (4.00–7.00 days), while the median follow-up period was 28.00 months (4.00–34.00 months). Conclusions The modified vein clamping technique for the treatment of renal cell carcinoma complicated with level I–II IVC thrombi may be a safe and technically feasible alternative technique.
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Affiliation(s)
- Jiaxing Ma
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Rd, Hefei, 230032, Anhui, People's Republic of China
| | - Wei Sun
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Rd, Hefei, 230032, Anhui, People's Republic of China
| | - Weiwei Qian
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Rd, Hefei, 230032, Anhui, People's Republic of China
| | - Jie Min
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Rd, Hefei, 230032, Anhui, People's Republic of China
| | - Tao Zhang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Rd, Hefei, 230032, Anhui, People's Republic of China
| | - Dexin Yu
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Rd, Hefei, 230032, Anhui, People's Republic of China.
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25
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Multidisciplinary surgical approach for renal cell carcinoma with inferior vena cava tumor thrombus. Surg Today 2021; 52:1016-1022. [PMID: 34786640 DOI: 10.1007/s00595-021-02415-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/12/2021] [Indexed: 10/19/2022]
Abstract
PURPOSES The optimal surgical management of renal cell carcinoma with tumor thrombus within the inferior vena cava (IVC) remains to be clarified. METHODS Sixteen consecutive cases were reviewed. Incision, the IVC clamping position, and the venous drainage procedure were modified according to the tumor thrombus extension level: level I or II (below the hepatic vein, n = 8), level III (above the hepatic vein but below the right atrium, n = 5), and level IV (extending into the right atrium, n = 3). RESULTS For level I or II, resection could be simply achieved by clamping the IVC below the hepatic vein, without hemodynamic collapse. For level III, clamping the IVC above the hepatic vein and the hepatoduodenal ligament was required. Venous drainage from the lower body (cannulation to distal IVC) and portal system (cannulation to ileocolic vein) were applied. When opening the IVC, the significant backflow was controlled using cardiopulmonary bypass with drop-in suckers. For level IV, median sternotomy, exposure of the right atrium, and cardiopulmonary bypass were mandatory. With the combination of these approaches, the perioperative mortality rate was 0% and the 5-year overall survival rate was 52%. CONCLUSIONS A multidisciplinary surgical approach is essential, especially for level III and IV cases.
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26
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Campi R, Marchioni M, Bertolo R, Erdem S, Kara O, Pavan N, Amparore D. Robotic surgery for renal cell carcinoma with inferior vena cava thrombosis: balancing feasibility and safety toward individualized decision-making. Minerva Urol Nephrol 2021; 73:544-548. [PMID: 34494415 DOI: 10.23736/s2724-6051.21.04606-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University "G. D'Annunzio" Chieti-Pescara, Chieti, Italy.,Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | | | - Selcuk Erdem
- Division of Urologic Oncology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Onder Kara
- School of Medicine, Department of Urology, University of Kocaeli, Kocaeli, Turkey
| | - Nicola Pavan
- Clinic of Urology, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Daniele Amparore
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
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27
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Ma S, Jia W, Hou G, Quan P, Zhang L, Fan X, Yang B, Su X, Jiao J, Wang F, Yuan J, Qin W, Yang X. Case reports of robot-assisted laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy: A retrospective analysis. Medicine (Baltimore) 2021; 100:e26886. [PMID: 34414942 PMCID: PMC8376354 DOI: 10.1097/md.0000000000026886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/21/2021] [Indexed: 01/04/2023] Open
Abstract
Renal cell carcinoma is one common type of urologic cancers. It has tendencies to invade into the inferior vena cava (IVC) and usually requires an open surgery procedure. High rates of operative complications and mortality are usually associated with an open surgery procedure. The recently emerged robot-assisted laparoscopic radical nephrectomy (RAL-RN) and IVC tumor thrombectomy have shown to reduce operative related complications in patients with renal cell carcinoma.This case series study aimed to summarize technical utilization, perioperative outcomes, and efficacies of RAL-RN and IVC tumor thrombectomy in our hospital. A retrospective analysis was performed on clinical data from 20 patients who underwent RAL-RN and IVC tumor thrombectomy from January 2017 to December 2019 in our department.Patients had a median age of 59 years (interquartile range [IQR], 46-68). Four patients had renal neoplasm on left side and 16 on right side. Nineteen patients underwent RAL-RN (level 0: n = 2) or RAL-RN with IVC thrombectomy (n = 17) (level I: n = 3; level II: n = 12; and level III: n = 3) and 1 patient was converted into an open surgery. The median operative time was 328 minutes (IQR, 221-453). The estimated median blood loss was 500 mL (IQR, 200-1200). The median size of removed renal carcinoma was 67 cm2 (IQR, 40-91); the length of IVC tumor thrombus was 5 cm (IQR, 3-7). The postsurgery hospital length of stay was 6 days (IQR, 5-7). The complications included intestinal obstruction (n = 1), lymphatic fistula (n = 1), heart failure (n = 1), and low hemoglobin level (n = 1). The outcomes for patients after 16 months (IQR, 11-21) follow-up were tumor-free (n = 10), tumor progression (n = 4), loss of contact (n = 1), and death (n = 5).We concluded that RAL-RN and IVC thrombectomy renders good safety profiles including minimal invasiveness, low estimated median blood loss, short hospitalization, low morbidity, and quick renal function recovery. The long-term efficacy needs a further investigation.
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Affiliation(s)
- Shuaijun Ma
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Weijing Jia
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Penghe Quan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Longlong Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Xiaozheng Fan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Bo Yang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Xing Su
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Jianhua Jiao
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Fuli Wang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Weijun Qin
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Xiaojian Yang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
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28
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Masic S, Smaldone MC. Robotic renal surgery for renal cell carcinoma with inferior vena cava thrombus. Transl Androl Urol 2021; 10:2195-2198. [PMID: 34159102 PMCID: PMC8185684 DOI: 10.21037/tau.2019.06.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Surgical management of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus is inherently complex, posing challenges for even the most experienced urologists. Until the mid-2000s, nephrectomy with IVC thrombectomy was exclusively performed using variations of the open technique initially described decades earlier, but since then several institutions have reported their robotic experiences. Robotic IVC thrombectomy was initially reported for level I and II thrombi, and more recently in higher-lever III thrombi. In general, the robotic approach is associated with less blood loss and shorter hospital stays compared to the open approach, low rates of open conversion in reported cases, relatively low rates of high-grade complications, and favorable overall survival on short-term follow-up in limited cohorts. Operative times are longer, costs are significantly higher, and left-sided tumors always require intraoperative repositioning and usually require preoperative embolization. To date, criteria for patient selection or open conversion have not been defined, and long-term oncologic outcomes are lacking. While the early published robotic experience demonstrates feasibility and safety in carefully selected patients, longer-term follow-up remains necessary. Patient selection, indications for open conversion, logistics of conversion particularly in emergent settings, necessity and safety of preoperative embolization, the value proposition, and long-term oncologic outcomes must all be clearly defined before this approach is widely adopted.
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Affiliation(s)
- Selma Masic
- Fox Chase Cancer Center, Philadelphia, PA, USA
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29
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Xue X, Wang D, Xiao Y, Ji Z, Xie Y. Functional paraganglioma with tumor thrombus in the inferior vena cava, first case report. Transl Androl Urol 2021; 10:1813-1820. [PMID: 33968670 PMCID: PMC8100850 DOI: 10.21037/tau-21-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Pheochromocytoma (PHEO) is a rare neuroendocrine that tumor originated from the adrenal medulla that secrets catecholamines. Tumors from extra-adrenal chromaffin tissues are called extra-adrenal PHEO or paraganglioma (PGL). To our knowledge, adrenal PHEO and subclinical PGL with inferior vena cava (IVC) invasion had been sporadically reported, while functional PGL with IVC tumor thrombus has not been publicly reported yet. Perioperative management of those diseases is less well established because of their multidisciplinary nature and rarity. We herein present a case of primary malignant PGL with IVC invasion. A 16-year-old female patient with a history of severe paroxysmal hypertension was admitted to Peking Union Medical College Hospital on suspicion of retroperitoneal mass. In-house diagnostic work-up revealed a malignant PGL with IVC invasion, inferior mesenteric artery encasement and, aorta engagement. Multi-disciplinary discussions were held and careful preoperative preparation plans were made. After everything was ready, the functional PGL and tumor thrombus were completely resected, then a reconstruction of IVC was performed. The patient was discharged on postoperative day 14 and all her clinical symptoms disappeared afterward. No evidence of tumor residual or metastasis was found in the subsequent six months of follow-up. Gene tests were made for her and her family. Albeit its rarity, functional PGL with IVC invasion is not unresectable, a multi-disciplinary task force should be established to settle down every detail. We recommended 3-dimensional imaging reconstruction for gaining a better anatomic understanding. Literature reviews showed that complete resection is the premise of a good prognosis. In particular cases, complementary or alternative therapy like chemotherapy and 131I-metaiodobenzylguanidine might help, family hereditary genetic tests are advised as well.
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Affiliation(s)
- Xiaoqiang Xue
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Xie
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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30
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Wu S, Peng C, Li HZ, Huang Q, Fan Y, Gao Y, Zhang X, Wang B, Ma X. Robotic retroperitoneal versus transperitoneal inferior vena cava thrombectomy: right-sided cases with level I-II tumor thrombus. J Endourol 2021; 35:1498-1503. [PMID: 33787317 DOI: 10.1089/end.2021.0127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To compare the perioperative hemodynamic consequences and oncology outcomes of robotic retroperitoneal versus transperitoneal inferior vena cava(IVC) thrombectomy(IVCT) for right renal cell carcinoma(RCC) with IVC tumor thrombus(IVCTT) that located below the first porta hepatis. PATIENTS AND METHODS Between January 2018 and June 2019, 35 patients of right RCC with IVCTT that located below the first porta hepatis underwent robotic retroperitoneal IVCT(16 patients) or transperitoneal IVCT(19 patients). We have described the procedures of transperitoneal IVCT earlier. The main procedure of robotic retroperitoneal IVCT include circumferential dissection of the IVC, sequentially clamping subhepatic IVC, the left renal vein and the caudal IVC with vessel loops, IVCT, IVC repair, radical nephrectomy(RN). The following parameters were compared between the two groups: baselines characteristic, perioperative consequences and hemodynamic changes. RESULTS Retroperitoneal and transperitoneal cohorts were comparable in terms of IVC thrombus length(3.2 vs 4.0 cm), IVC block time (18 vs 16 min, p=0.64), postoperative hospital stay (6 vs 6 days, p= 0.67), postoperative complications (0 vs 0), and recurrence or metastasis rate(0 vs 0) for patients with similar baseline characteristic. The retroperitoneal cohort tended to less blood loss (160 vs 240ml,p=0.024), shorter operative time(130 vs 145min,p=0.003), lower central venous pressure(p<0.05) and smaller diameter of IVC (p<0.05). CONCLUSIONS Robotic retroperitoneal RN and IVCT is feasible for patients of right RCC with IVCTT located below the first porta hepatis and is superior to transperitoneal IVCT in terms of bleeding control and operation time for skilled surgeons.
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Affiliation(s)
- Shengpan Wu
- Chinese PLA General Hospital, Urology, Beijing , Haidian District, Urology, No. 28,Fuxing Road,Chinese PLA General Hospital, Beijing, China, 100853;
| | - Cheng Peng
- Chinese PLA General Hospital, Urology, Beijing, Beijing, China;
| | - Hong Zhao Li
- Chinese PLA general hospital, urology, Beijng, China;
| | - Qingbo Huang
- Chinese PLA General Hospital, Urology, Beijing, Beijing, China;
| | - Yang Fan
- Chinese PLA General Hospital, Urology, Beijing, Beijing, China;
| | - Yu Gao
- Chinese PLA General Hospital, Urology, 28, Fuxing Road, Haidian District, Beijing, Beijing, China, 100853;
| | - Xu Zhang
- Chinese PLA General Hospital, Department of Urology, No 28 Fuxing Road, Beijing, Beijing, China, 100853;
| | - Baojun Wang
- Chinese PLA General Hospital, 104607, Urology, 28 Fu Xing Road, Haidian District, Beijing, China, 100853;
| | - Xin Ma
- Chinese PLA General Hospital, Urology, 28 Fu Xing Road, Beijing 100853, China., Beijing, Beijing, China, 100853;
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31
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Wang H, Li X, Huang Q, Panic A, Shen D, Jia W, Zhang F, Fan Y, Gao Y, Gu L, Liu K, Peng C, Chen C, Duan J, Chen J, Wu S, Xuan Y, Wang C, Li H, Ma X, Zhang X, Wang B. Prognostic role of bland thrombus in patients treated with resection of renal cell carcinoma with inferior vena cava tumor thrombus. Urol Oncol 2021; 39:302.e1-302.e7. [PMID: 33678501 DOI: 10.1016/j.urolonc.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/19/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the impact of the presence of bland thrombus (BT) on prognosis of patients treated with resection of renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (IVCTT). MATERIALS AND METHODS The medical records of a total of 145 consecutive postsurgical RCC patients with level I-IV IVCTT were reviewed from January 2008 to August 2018. Associations of BT with clinicopathological variables were estimated by chi-square test or Student's t-test. Kaplan-Meier method and multivariate Cox proportional hazard model were used. The eighth TNM staging system, "Spiess PE" model, University of California at Los Angeles Integrated Staging System and Stage, Size, Grade, and Necrosis (SSIGN) score were selected to assess whether BT could improve their predictive abilities. RESULTS BT was observed in 34 (23.4%) patients and was significantly associated with increased levels of IVCTT (P = 0.004) and invasion of IVC wall (P = 0.030). Multivariable Cox analyses revealed that tumor grade, T stage, M stage, tumor thrombus consistency and BT were independent risk factors for both progression-free survival and overall survival. The concordance indexes ranged from a low of 0.652 in TNM to a high of 0.731 in SSIGN, and integrating BT into each base model led to an increased predictive accuracies of 6.2% for TNM (P = 0.025), 4.0% for "Spiess PE" model (P = 0.069), 2.1% for University of California at Los Angeles Integrated Staging System (P = 0.149) and 1.2% for SSIGN (P = 0.290), respectively. CONCLUSIONS Presence of BT was independently associated with survival in postsurgical patients with RCC-IVCTT. Routine consideration of BT as an adjunct to TNM staging system may be suggested.
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Affiliation(s)
- Hanfeng Wang
- Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Xintao Li
- Department of Urology, Air Force Medical Center, Beijing 100142, China
| | - Qingbo Huang
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Andrej Panic
- Department of Urology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Donglai Shen
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Wangping Jia
- Medical School of Chinese PLA, Beijing 100853, China.; Institute of geriatrics/National Clinical Research Center for Geriatrics Diseases, the Second Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Fan Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Yang Fan
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Yu Gao
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Kan Liu
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Cheng Peng
- Department of Urology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing 100007, China
| | - Changyu Chen
- Medical School of Chinese PLA, Beijing 100853, China.; School of Medicine, Nankai University, Tianjin 300071, China
| | - Junyao Duan
- Department of Urology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100007, China
| | - Jianwen Chen
- Medical School of Chinese PLA, Beijing 100853, China.; Dpartment of Nephrology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Shengpan Wu
- Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Yundong Xuan
- Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Chenfeng Wang
- Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853
| | - Xin Ma
- Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853.
| | - Xu Zhang
- Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853.
| | - Baojun Wang
- Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853.
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Jurado A, Romeo A, Gueglio G, Marchiñena PG. Current Trends in Management of Renal Cell Carcinoma with Venous Thrombus Extension. Curr Urol Rep 2021; 22:23. [PMID: 33554309 DOI: 10.1007/s11934-021-01036-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW To review the evidence regarding the current trends in surgical management of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombosis. Recent published series have shown the role of minimally invasive surgery in IVC thrombectomy. This review article evaluates the present RCC with venous extent literature to assess the role of open and minimally invasive surgery in this scenario. RECENT FINDINGS Robotic urological surgery has shown to have known benefits in radical prostatectomy, partial nephrectomy, and pyeloplasty. Recent published series showed feasibility of robotic IVC thrombectomy even for level IV cases. With growing number of robot-assisted and laparoscopic surgeries worldwide, there is a current tendency to treat this complex and challenging pathology with a minimally invasive approach, without compromising oncological outcomes.
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Affiliation(s)
- Alberto Jurado
- Urology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Agustin Romeo
- Urology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
| | - Guillermo Gueglio
- Urology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Patricio Garcia Marchiñena
- Urology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
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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: 10] [Impact Index Per Article: 2.5] [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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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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Vuong NS, Ferriere JM, Michiels C, Calen L, Tesi L, Capon G, Bensadoun H, Alezra E, Estrade V, Robert G, Bladou F, Bernhard JC. Robot-assisted versus open surgery for radical nephrectomy with level 1-2 vena cava tumor thrombectomy: a French monocenter experience (UroCCR study #73). Minerva Urol Nephrol 2020; 73:498-508. [PMID: 33200900 DOI: 10.23736/s2724-6051.20.04052-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this paper was to assess the feasibility of robot-assisted radical nephrectomy (RN) with inferior vena cava thrombectomy (RRVCT) and compare perioperative and oncological outcomes of this approach to open surgery for renal tumors with level 1-2 inferior vena cava (IVC) thrombus. METHODS We performed a retrospective analysis of patients surgically treated for renal cancer with IVC level 1-2 thrombus in the Urology department of Bordeaux University Hospital between December 2015 and December 2019. Patients were stratified by surgical approach in two groups: open vs. robotic procedures. Pre-, per- and postoperative data were collected within the framework of the UroCCR project (NCT03293563). Univariate and multivariate analysis using regression models were performed. RESULTS A total of 40 patients underwent RN with IVC tumor thrombus. Open and robotic surgery represented respectively 30 and 10 cases. The two groups were comparable regarding pre-operative tumor and patient characteristics. Robotic procedures were associated with lower estimated blood loss (EBL) (500 vs. 1250 mL, P=0.02), shorter Intensive Care Unit stay (2 vs. 4 days, P=0.03) and decrease of global length of stay (LOS) (7 vs. 10 days, P<0.01). Operative Time (OT) was significantly longer in the robotic group (350.5 vs. 208 min, P<0.01). No difference were observed between the two approaches regarding complications and oncological outcomes. CONCLUSIONS Robotic approach induced lower bleeding and shorter LOS but required longer OT. This technique is feasible and safe for selected cases and experimented surgical teams. Complications rate and oncological outcomes are not different compared to standard open procedures.
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Affiliation(s)
- Nam-Son Vuong
- Department of Urology, Bordeaux University Hospital, Bordeaux, France -
| | | | - Clément Michiels
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Laura Calen
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Lorenso Tesi
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Grégoire Capon
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Henri Bensadoun
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Eric Alezra
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Vincent Estrade
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Grégoire Robert
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Franck Bladou
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
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Ghoreifi A, Djaladat H. Surgical Tips for Inferior Vena Cava Thrombectomy. Curr Urol Rep 2020; 21:51. [PMID: 33090290 DOI: 10.1007/s11934-020-01007-9] [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] [Accepted: 10/15/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to describe the preoperative evaluation, surgical techniques, and postoperative management of patients with renal cell carcinoma (RCC) undergoing radical nephrectomy (RN) and inferior vena cava (IVC) thrombectomy. RECENT FINDINGS RN and IVC thrombectomy remains the standard management option in non-metastatic RCC patients with IVC thrombus. A comprehensive preoperative workup, including high-quality imaging, blood works, and appropriate consultations are required for all patients. The aim of the surgery is complete resection of all tumor burden, which requires a skillful surgical team for such a challenging procedure and is inherently associated with a high rate of perioperative morbidity and mortality. Preoperative CT or MRI is essential for surgical planning. The surgical approach is mainly determined by the level of the tumor thrombus. The open approach has been the standard, though minimally invasive and robotic techniques are emerging in selected cases by experienced surgeons.
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Affiliation(s)
- Alireza Ghoreifi
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave. Suite 7416, Los Angeles, CA, 90089, USA
| | - Hooman Djaladat
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave. Suite 7416, Los Angeles, CA, 90089, USA.
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Complex robotic nephrectomy and inferior vena cava tumor thrombectomy: an evolving landscape. Curr Opin Urol 2020; 30:83-89. [PMID: 31725003 DOI: 10.1097/mou.0000000000000690] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Robotic nephrectomy for complex renal masses and in the setting of inferior vena cava (IVC) tumor thrombus has been shown to be a well tolerated and reproducible surgical option. Recent developments in such procedures will be discussed as they continue to evolve. RECENT FINDINGS Multiple case series have demonstrated the application of robotic surgery in the management of the most complex renal tumors and for IVC thrombi with acceptable oncologic and perioperative outcomes. Prior to the advent of robotic surgery, massive tumors, contiguous organ invasion, need for lymphadenectomy, and IVC tumor thrombus were thought by many to require open surgery. Since 2011, several studies have reported robotic nephrectomy for complex tumors with recent comparisons of robotic and open approaches finding similar oncologic and survival outcomes but with shorter length of stay (LOS) and less blood loss with robotic surgery. SUMMARY Robotic surgery is a feasible and well tolerated alternative to open surgery for the management of complex renal tumors and IVC thrombi. The potential benefits of shorter LOS, less blood loss, and earlier convalescence suggest this approach should continue to be evaluated. Patient selection and surgeon experience are of paramount importance.
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Imaging predictors for assessment of inferior vena cava wall invasion in patients with renal cell carcinoma and inferior vena cava tumor thrombus: a retrospective study. Chin Med J (Engl) 2020; 133:2078-2083. [PMID: 32898352 PMCID: PMC7478742 DOI: 10.1097/cm9.0000000000000828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Renal cell carcinoma (RCC) has the propensity to lead to venous tumor thrombus (VTT). Nephrectomy with tumor thrombectomy is an effective treatment option but is a technically challenging surgical procedure that is accompanied by a high rate of complications. The aims of this study were to investigate pre-operative imaging parameters for the assessment of inferior vena cava (IVC) wall invasion due to a tumor thrombus in patients with RCC and to identify predictors from the intra-operative findings. Methods Clinical and imaging data were collected from 110 patients who underwent nephrectomy with IVC tumor thrombectomy (levels I–IV) for RCC and IVC tumor thrombus at the Peking University Third Hospital between May 2015 and March 2018. Univariable and multivariable logistic regression and receiver operating characteristic curves were used to assess the correlations between pre-operative imaging features and intra-operative macroscopic invasions of the IVC wall by tumor thrombus. Results Among the 110 patients, 41 underwent partial or segmental resection of IVC. There were univariate associations of pre-operative imaging parameters that could be used to predict the need for IVC resection, including those of the Mayo classification, maximum anterior-posterior (AP) diameter of the renal vein at the renal vein ostium (RVo), maximum AP diameter of the VTT at the RVo and IVC occlusion. For the multivariable analysis, the AP diameter of the VTT at the RVo and IVC occlusion were associated with a significantly increased risk of invasion of the IVC wall by tumor thrombus. The optimum imaging thresholds included an AP diameter of the VTT at the RVo larger than 17.0 mm and the presence of IVC occlusion, with which we predicted invasions of the IVC wall requiring IVC resection. The probabilities of intra-operative IVC resection for patients without both independent factors, with an AP diameter of the VTT at the RVo larger than 17.0 mm, with IVC occlusion, and with both concurrent factors were 5%, 23%, 56%, and 66%, respectively. Conclusion An increase in the AP VTT diameter at the RVo and the presence of complete occlusion of the IVC are independent risk factors for a high probability of IVC wall invasion by tumor thrombus.
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Immediate preoperative renal artery embolization in the resection of complex renal tumors (UroCCR-48 Reinbol study). Int Urol Nephrol 2020; 53:229-234. [PMID: 32880091 DOI: 10.1007/s11255-020-02628-2] [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: 07/05/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We evaluated the feasibility and outcomes of immediate preoperative renal artery embolization (IPRAE) before complex nephrectomy for locally advanced RCC ± inferior vena cava thrombus (IVCT). METHODS A comparative retrospective (2007-2017) multicenter study which included 145 patients with locally advanced RCC ± IVCT: 99 radical nephrectomies vs. 46 radical nephrectomies with IPRAE identified in the prospective UroCCR national database (CNIL DR 2013-206; NCT03293563). IPRAE was performed under local anesthesia the day of nephrectomy (< 4 h prior to nephrectomy). The primary endpoint was peroperative blood loss (mL). Secondary outcomes were: tolerance of embolization (pain visual scale), success rate of IPRAE defined by complete devascularization of the kidney, perioperative complications according to Clavien score and postoperative GFR. RESULTS The baseline characteristics of IPRAE and the control groups were similar. Tumor staging was 14% T2b, 41% T3a, 27% T3b, 13% T3c, 6% T4. The success rate of IPRAE was 98%. Median artery embolizated per patient was 2 (Agochukwu and Shuch in World J Urol 32:581-589, 2014; Marshall et al. in J Urol 139:1166-1172, 1988; Yap et al. in BJU Int 110:1283-1288, 2012;Gill et al. in J Urol. 194:929-938, 2015; Wang et al. in Eur Urol 69:1112-1119, 2016). No severe complications occurred after IPRAE. Postembolization syndrome was reported in 7% (Clavien I-II). Mean peroperative blood losses in the IPRAE and control groups were: 726 ± 118 ml and 1083 ± 114 ml (P = 0.03). In a multivariate analysis that included: age, Karnofsky index, IPRAE (yes vs. no), IVCT (yes vs. no), tumor size and synchronous metastasis, no IPRAE and IVCT were significantly associated with increased peroperative bleeding. CONCLUSION IPRAE before nephrectomy for locally advanced and/or IVCT tumors was well tolerated, was associated with lower peroperative bleeding and did not increase the incidence or severity of postoperative complications.
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Du S, Zhang X, Ma X, Wang B. AUTHOR REPLY. Urology 2020; 142:132. [DOI: 10.1016/j.urology.2020.03.056] [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]
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Jia Z, Wang BJ, Li X, Zhang X. Pheochromocytoma with delayed tumor thrombus detection in renal vein: A case report. World J Clin Cases 2020; 8:2849-2854. [PMID: 32742994 PMCID: PMC7360707 DOI: 10.12998/wjcc.v8.i13.2849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pheochromocytomas with inferior vena cava (IVC) or renal vein tumor thrombus are rare. Surgical management is the first choice.
CASE SUMMARY We presented a 42-year-old man with adrenal pheochromocytoma and delayed tumor thrombus detection in the renal vein at the entrance of the IVC three months after adrenalectomy. We performed laparoscopic adrenalectomy during the first surgery and robot-assisted laparoscopic nephrectomy and resection of tumor thrombus during the second surgery.
CONCLUSION We report the surgical management of a patient with adrenal pheochromocytoma with tumor thrombus at the entrance of the IVC. Robot-assisted laparoscopic surgery is safe and efficient.
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Affiliation(s)
- Zhuo Jia
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing 100853, China
| | - Bao-Jun Wang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing 100853, China
| | - Xing Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing 100853, China
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing 100853, China
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Wang B, Huang Q, Liu K, Fan Y, Peng C, Gu L, Shi T, Zhang P, Chen W, Du S, Niu S, Liu R, Zhao G, Li Q, Xiao C, Wang R, Li S, Wang M, Liu F, Wang H, Li H, Ma X, Zhang X. Robot-assisted Level III-IV Inferior Vena Cava Thrombectomy: Initial Series with Step-by-step Procedures and 1-yr Outcomes. Eur Urol 2020; 78:77-86. [DOI: 10.1016/j.eururo.2019.04.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/12/2019] [Indexed: 11/15/2022]
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Seetharam Bhat KR, Moschovas MC, Onol FF, Rogers T, Roof S, Patel VR, Schatloff O. Robotic renal and adrenal oncologic surgery: A contemporary review. Asian J Urol 2020; 8:89-99. [PMID: 33569275 PMCID: PMC7859360 DOI: 10.1016/j.ajur.2020.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/30/2020] [Accepted: 04/22/2020] [Indexed: 01/20/2023] Open
Abstract
Robot-assisted surgery has evolved over time. Radical nephrectomy with inferior vena cava thrombectomy is feasible and safe for level I, II and III thrombus in high volume centers. Though it is feasible for level IV thrombus, this procedure needs a multi-departmental co-operation. However, the safety of robot-assisted procedures in this subset is still unknown. Robot-assisted partial nephrectomy has been universally approved and found oncologically safe. Robotic adrenalectomy has been increasingly utilized for select cases, especially in bilateral tumors and for retroperitoneal adrenalectomy.
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Affiliation(s)
| | | | - Fikret Fatih Onol
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Travis Rogers
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Shannon Roof
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Vipul R Patel
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Oscar Schatloff
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA.,Sudmedica Health, Chile
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Liu Z, Zhao X, Zhang HX, Ma RZ, Li LW, Tang SY, Wang GL, Zhang SD, Wang SM, Tian XJ, Ma LL. Peking University Third Hospital score: a comprehensive system to predict intra-operative blood loss in radical nephrectomy and thrombectomy. Chin Med J (Engl) 2020; 133:1166-1174. [PMID: 32433048 PMCID: PMC7249704 DOI: 10.1097/cm9.0000000000000799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Radical nephrectomy and thrombectomy is the standard surgical procedure for the treatment of renal cell carcinoma (RCC) with tumor thrombus (TT). But the estimation of intra-operative blood loss is only based on the surgeon's experience. Therefore, our study aimed to develop Peking University Third Hospital score (PKUTH score) for the prediction of intra-operative blood loss volume in radical nephrectomy and thrombectomy. METHODS The clinical data of 153 cases of renal mass with renal vein (RV) or inferior vena cava tumor thrombus admitted to Department of Urology, Peking University Third Hospital from January 2015 to May 2018 were retrospectively analyzed. The total amount of blood loss during operation is equal to the amount of blood sucked out by the aspirator plus the amount of blood in the blood-soaked gauze. Univariate linear analysis was used to analyze risk factors for intra-operative blood loss, then significant factors were included in subsequent multivariable linear regression analysis. RESULTS The final multivariable model included the following three factors: open operative approach (P < 0.001), Neves classification IV (P < 0.001), inferior vena cava resection (P = 0.001). The PKUTH score (0-3) was calculated according to the number of aforementioned risk factors. A significant increase of blood loss was noticed along with higher risk score. The estimated median blood loss from PKUTH score 0 to 3 was 280 mL (interquartile range [IQR] 100-600 mL), 1250 mL (IQR 575-2700 mL), 2000 mL (IQR 1250-2900 mL), and 5000 mL (IQR 4250-8000 mL), respectively. Meanwhile, the higher PKUTH score was, the more chance of post-operative complications (P = 0.004) occurred. A tendency but not significant overall survival difference was found between PKUTH risk score 0 vs. 1 to 3 (P = 0.098). CONCLUSION We present a structured and quantitative scoring system, PKUTH score, to predict intra-operative blood loss volume in radical nephrectomy and thrombectomy.
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Affiliation(s)
- Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Xun Zhao
- Health Science Center, Peking University, Beijing 100191, China
| | - Hong-Xian Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Run-Zhuo Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Li-Wei Li
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Shi-Ying Tang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Guo-Liang Wang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Shu-Dong Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Shu-Min Wang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Xiao-Jun Tian
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Lu-Lin Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
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Du S, Huang Q, Yu H, Shen D, Gu L, Yan F, Liu F, Zhang X, Ma X, Wang B. Initial Series of Robotic Segmental Inferior Vena Cava Resection in Left Renal Cell Carcinoma With Caval Tumor Thrombus. Urology 2020; 142:125-132. [PMID: 32339559 DOI: 10.1016/j.urology.2020.03.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To present our preliminary experience of robotic left radical nephrectomy (LRN) and segmental inferior vena cava (IVC) resection without caval replacement for left renal cell carcinoma (RCC) with inferior vena cava tumor thrombus. MATERIALS AND METHODS Between 2017 and 2018, 7 patients underwent segmental IVC resection and LRN robotically. All patients underwent preoperative cavography, demonstrating complete IVC occlusion. Computed tomography-based 3-dimensional reconstruction revealed sufficient collateralization of the IVC and right renal vein (RRV). The cephalic IVC was circumferentially resected and ligated just below the second porta hepatis. The caudal IVC was circumferentially resected above the RRV with preservation of the major collaterals. The RRV was not dissected during the procedure to avoid compromising its neocollaterals. The IVC portion between the RRV and the second porta hepatis was removed en bloc with the tumor thrombus, and the LRN was performed. RESULTS All cases were successfully performed by robotic surgery without conversion. Median operative time was 420 minutes. Median intensive care unit stay was 3 days. Four grade Ⅱ complications occurred in 2 patients. One patient had mild LEE postoperatively and recovered without special medication. Median preoperative and 3-6 months follow-up serum creatinine was 118.7 μmol/L and 135.2 μmol/L, respectively. No patient needed dialysis postoperatively. One case occurred disease progression. No patient died during the follow-up period. CONCLUSION Robotic segmental IVC resection for left RCC with inferior vena cava tumor thrombus is feasible in well-selected cases. Three-dimensional reconstruction and cavography are helpful in the preoperative evaluation of neocollaterals in patients with suprarenal IVC occlusion.
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Affiliation(s)
- Songliang Du
- School of Medicine, Nankai University, Tianjin, China; Department of Urology/ State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, China
| | - Qingbo Huang
- Department of Urology/ State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, China
| | - Hongkai Yu
- Department of Urology/ State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, China
| | - Donglai Shen
- Department of Urology/ State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, China
| | - Liangyou Gu
- Department of Urology/ State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, China
| | - Fei Yan
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Fengyong Liu
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xu Zhang
- School of Medicine, Nankai University, Tianjin, China; Department of Urology/ State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xin Ma
- School of Medicine, Nankai University, Tianjin, China; Department of Urology/ State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, China
| | - Baojun Wang
- School of Medicine, Nankai University, Tianjin, China; Department of Urology/ State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, China.
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Tian X, Hong P, Liu Z, Huang Y, Wang G, Hou X, Zhang S, Ma L. En bloc retroperitoneal laparoscopic radical nephrectomy with inferior vena cava thrombectomy for renal cell carcinoma with level 0 to II venous tumor thrombus: A single-center experience. Cancer 2020; 126 Suppl 9:2073-2078. [PMID: 32293727 DOI: 10.1002/cncr.32747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The surgical treatment of patients with renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is challenging. In the current study, the authors have reported their surgical outcomes and experience with en bloc retroperitoneal laparoscopic radical nephrectomy (LRN) with inferior vena cava (IVC) thrombectomy for patients with RCC with level 0 to II VTT. METHODS A retrospective review of the clinical records of 78 patients who underwent retroperitoneal LRN with IVC thrombectomy from March 2015 to September 2018 was performed. The surgical procedures included establishing the retroperitoneal space, ligating and severing the renal artery, clamping the renal vein and IVC, incising the IVC, and placing the renal and tumor thrombus en bloc into a retrieval bag. RESULTS According to the Mayo classification, the tumor thrombus was level 0, I, and II, respectively, in 28 patients, 27 patients, and 23 patients. The median operative time, estimated blood loss, and postoperative hospital stay were 256 minutes, 400 mL, and 8 days, respectively. A total of 67 patients were not converted to open surgery. No patient died during surgery, and no tumor embolization occurred. Thirteen patients experienced complications. The pathological reports indicated clear cell RCC in 70 patients and other RCC in 8 patients. The median follow-up was 14.5 months, and 61 patients were alive at the time of last follow-up. CONCLUSIONS En bloc retroperitoneal LRN with IVC thrombectomy is a challenging but feasible procedure for experienced surgeons in patients with RCC with level 0 to II VTT.
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Affiliation(s)
- Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Yi Huang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Xiaofei Hou
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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Huang Q, Gu L, Zhu J, Peng C, Du S, Liu Q, Chen J, Wang B, Fan Y, Gao Y, Fam X, Wang H, Liu F, Guo A, Li H, Zhang X, Ma X. A three-dimensional, anatomy-based nephrometry score to guide nephron-sparing surgery for renal sinus tumors. Cancer 2020; 126 Suppl 9:2062-2072. [PMID: 32293724 DOI: 10.1002/cncr.32748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/28/2019] [Accepted: 01/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND A quantitative nephrometry scoring system specifically for renal sinus tumors will assist in classifying surgical complexity and treatment planning. METHODS By using preoperative computed tomography, magnetic resonance imaging, and 3-dimensional image reconstruction, 5 critical components were assessed: the ratio of the sinus area occupied by the tumor in relation to the whole sinus area (R), the compression of the renal segmental vessels or collection system by the tumor (O), the anteroposterior relation of the tumor relative to the segmental vessels or collection system (A), the tumor diameter (D), and whether the tumor affects a solitary kidney (S) ("ROADS"). The ROADS score, indicating low, moderate, or high surgical complexity, was then used to guide surgical strategy planning, including cooling techniques, surgical approaches, and parenchyma incision techniques. A cohort of 134 patients with renal sinus tumors was treated based on their ROADS score and was retrospectively analyzed. RESULTS The authors successfully performed 113 nephron-sparing surgeries and 21 radical nephrectomies with a complication rate of 7.9%. During follow-up, 3 cases were classified according to surgical margin status because they lacked an intact tumor capsule. There was only 1 case of local recurrence, and there were no cases of metastasis. A high ROADS score was correlated with greater operative complexity, such as longer operation and ischemia times and higher estimated blood loss and complication rates. However, renal function and short-term oncologic outcomes were not related to the score. CONCLUSIONS The ROADS scoring system provides a standardized, quantitative, 3-dimensional anatomic classification to guide surgical strategy in renal sinus tumors.
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Affiliation(s)
- Qingbo Huang
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital/PLA Medical School, Beijing, China
| | - Liangyou Gu
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital/PLA Medical School, Beijing, China
| | - Jie Zhu
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital/PLA Medical School, Beijing, China
| | - Cheng Peng
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital/PLA Medical School, Beijing, China
| | - Songliang Du
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital/PLA Medical School, Beijing, China
| | - Qiming Liu
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital/PLA Medical School, Beijing, China
| | - Jianwen Chen
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital/PLA Medical School, Beijing, China
| | - Baojun Wang
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital/PLA Medical School, Beijing, China
| | - Yang Fan
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital/PLA Medical School, Beijing, China
| | - Yu Gao
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital/PLA Medical School, Beijing, China
| | - Xenginn Fam
- Urology Unit, Department of Surgery, Kebangsaan Malaysia University Medical Center, Kuala Lumpur, Malaysia
| | - Haiyi Wang
- Department of Radiology, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Fengyong Liu
- Department of Interventional Radiology, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Aitao Guo
- Department of Pathology, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Hongzhao Li
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital/PLA Medical School, Beijing, China
| | - Xu Zhang
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital/PLA Medical School, Beijing, China
| | - Xin Ma
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital/PLA Medical School, Beijing, China
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Kishore TA, Pathrose G, Raveendran V, Ganpule A, Gautam G, Laddha A, Pooleri GK, Desai M. Robot-assisted laparoscopic radical nephrectomy and inferior vena cava thrombectomy: A multicentre Indian experience. Arab J Urol 2020; 18:124-128. [PMID: 33029418 PMCID: PMC7473165 DOI: 10.1080/2090598x.2020.1738104] [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: 11/24/2022] Open
Abstract
Objective To assess feasibility of robot-assisted laparoscopic radical nephrectomy (RALRN) and inferior vena cava thrombectomy (IVCT) in treating renal tumours with level I–III IVC thrombi and to assess their outcomes. Patients and methods We conducted a retrospective analysis of RALRN-IVCTs, involving four centres across India, from September 2015 to June 2019. We analysed patients who underwent RALRN-IVCT for level I–III thrombi according to the Mayo classification. The total operative duration with console time, length of hospital stay, preoperative and postoperative creatinine, IVC clamp time and intraoperative blood loss were recorded. Results Of the 13 patients that underwent RALRN-IVCT, five had a level I thrombus, seven had level II, and one had a level III thrombus. In all, 11 of the patients had right-sided tumours and the remaining two had left-sided tumours. The mean (SD) age of the patients was 56.5 (12.3) years, the mean (SD) operative time was 329.5 (97.22) min, the mean (SD) console time was 222.5 (70) min, the mean (SD) blood loss was 395 (170) mL, and the mean (SD) IVC clamp time was 19.14 (9.5) min. The mean (SD) length of hospital stay was 7.8 (3.27) days. Of the 13 patients, 12 had clear cell renal cell carcinoma (RCC) and one had papillary RCC. The mean (range) follow-up was 19 (4–50) months. One patient had upfront metastasis and two patients developed metastasis, while 10 patients remained disease-free during the follow-up. Conclusion With appropriate patient selection, surgical planning and robotic experience, completely intracorporeal robotic level I–III IVCT is feasible and can be performed efficiently. Larger experiences, with longer follow-ups and comparisons with open surgery are needed to confirm these initial outcomes. Abbreviations ECOG: Eastern Cooperative Oncology Group; IVC: inferior vena cava; IVCT: inferior vena cava thrombectomy; (RAL)RN: (robot-assisted laparoscopic) radical nephrectomy
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Affiliation(s)
| | | | | | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urology Hospital, Nadiad, India
| | - Gagan Gautam
- Department of Urology, Max Hospital Saket, New Delhi, India
| | - Abhishek Laddha
- Department of Urology, Amrita Institute of Medical Sciences, Kochi, India
| | | | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urology Hospital, Nadiad, India
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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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Shen D, Wang H, Wang C, Huang Q, Li S, Wu S, Xuan Y, Gong H, Li H, Ma X, Wang B, Zhang X. Cumulative Sum Analysis of the Operator Learning Curve for Robot-Assisted Mayo Clinic Level I-IV Inferior Vena Cava Thrombectomy Associated with Renal Carcinoma: A Study of 120 Cases at a Single Center. Med Sci Monit 2020; 26:e922987. [PMID: 32107362 PMCID: PMC7063847 DOI: 10.12659/msm.922987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background This study aimed to use cumulative sum analysis of the operator learning curve for robot-assisted Mayo Clinic level I–IV inferior vena cava (IVC) thrombectomy associated with renal carcinoma, and describes the development of an optimized operative procedure at a single center. Material/Methods A retrospective study included 120 patients with Mayo Clinic level I–IV IVC thrombus who underwent robotic surgery between 2013 and 2018. Points in the learning curve were identified using cumulative sum analysis, and their impact was assessed by multiple regression analysis. Perioperative indicators analyzed included operative time, estimated blood loss, early complications, and the 90-day progression rate. Results Cumulative sum analysis identified three phases in the learning curve of robot-assisted IVC thrombectomy. The median operative time decreased from 265 min (range, 212–401 min) to 207 min (range, 146–276 min) (p=0.003), the median estimated blood loss decreased from 775 ml (range, 413–1500 ml) to 300 ml (range, 163–813 ml) (p=0.006), and the early complication rate decreased from 52.5% to 15.0% (p<0.001). Multivariate analysis showed that for an initial 40 cases and a further 80 cases, the learning phase, the affected side, the Mayo Clinic level, and the surgical method were independent factors that affected operative time, estimated blood loss, and the rate of early complications. Conclusions Experience from an initial 40 cases and a further 80 cases of Mayo Clinic level I–IV IVC thrombectomy associated with renal carcinoma were found to provide acceptable surgical and clinical outcomes.
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Affiliation(s)
- Donglai Shen
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Hanfeng Wang
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Chenfeng Wang
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Qingbo Huang
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Shichao Li
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Shengpan Wu
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Yundong Xuan
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Huijie Gong
- Department of Urology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Hongzhao Li
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Xin Ma
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Baojun Wang
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Xu Zhang
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
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