Robot-assisted Cavectomy Versus Thrombectomy for Level II Inferior Vena Cava Thrombus: Decision-making Scheme and Multi-institutional Analysis
Robot-assisted thrombectomy (RAT) for inferior vena cava (IVC) thrombus (RAT-IVCT) is being increasingly reported. However, the techniques and indications for robot-assisted cavectomy (RAC) for IVC thrombus are not well described. To develop a decision-making program and analyze multi-institutional...
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| Veröffentlicht in: | European urology 2020-10, Vol.78 (4), p.592-602 |
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| creator | Shi, Taoping Huang, Qingbo Liu, Kan Du, Songliang Fan, Yang Yang, Luojia Peng, Cheng Shen, Dan Wang, Zhongxin Gao, Yu Gu, Liangyou Niu, Shaoxi Ai, Qing Li, Hongzhao Liu, Fengyong Li, Qiuyang Wang, Haiyi Guo, Aitao Fu, Bin Yang, Xiaojian Zhang, Xuepei Wang, Delin Wang, Dongwen Guo, Hongqian Li, Hengping Olivero, Alberto Fam, Xeng Inn Ma, Xin Wang, Baojun Zhang, Xu |
| description | Robot-assisted thrombectomy (RAT) for inferior vena cava (IVC) thrombus (RAT-IVCT) is being increasingly reported. However, the techniques and indications for robot-assisted cavectomy (RAC) for IVC thrombus are not well described.
To develop a decision-making program and analyze multi-institutional outcomes of RAC-IVCT versus RAT-IVCT.
Ninety patients with renal cell carcinoma (RCC) with level II IVCT were included from eight Chinese urological centers, and underwent RAC-IVCT (30 patients) or RAT-IVCT (60 patients) from June 2013 to January 2019.
The surgical strategy was based on IVCT imaging characteristics. RAT-IVCT was performed with standardized cavotomy, thrombectomy, and IVC reconstruction. RAC-IVCT was mainly performed in patients with extensive IVC wall invasion when the collateral blood vessels were well-established. For right-sided RCC, the IVC from the infrarenal vein to the infrahepatic veins was stapled. For left-sided RCC, the IVC from the suprarenal vein to the infrahepatic veins was removed and caudal IVC reconstruction was performed to ensure the right renal vein returned through the IVC collaterals.
Clinicopathological, operative, and survival outcomes were collected and analyzed.
All procedures were successfully performed without open conversion. The median operation time (268 vs 190 min) and estimated blood loss (1500 vs 400 ml) were significantly greater for RAC-IVCT versus RAT-IVCT (both p < 0.001). IVC invasion was a risk factor for progression-free and overall survival at midterm follow-up. Large-volume and long-term follow-up studies are needed.
RAC-IVCT or RAT-IVCT represents an alternative minimally invasive approach for selected RCC patients with level II IVCT. Selection of RAC-IVCT or RAT-IVCT is mainly based on preoperative IVCT imaging characteristics, including the presence of IVC wall invasion, the affected kidney, and establishment of the collateral circulation.
In this study we found that robotic surgeries for level II inferior vena cava thrombus were feasible and safe. Preoperative imaging played an important role in establishing an appropriate surgical plan.
Robot-assisted cavectomy (RAC) for inferior vena cava thrombus (IVCT) is safe and feasible in patients with extensive IVC wall invasion if the collateral blood vessels are well established. Selection of RAC or robot-assisted thrombectomy for IVCT can be based on preoperative IVCT imaging characteristics, including the presence of IVC wall invasion, the affected kid |
| doi_str_mv | 10.1016/j.eururo.2020.03.020 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2392465432</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0302283820301950</els_id><sourcerecordid>2392465432</sourcerecordid><originalsourceid>FETCH-LOGICAL-c362t-1bd24b1ab67adebd9b53b97b5c37fea637863308395de7d2e70d222b30ef166f3</originalsourceid><addsrcrecordid>eNp9kc2O0zAUhS0EYkrhDRDykk2C49vYCQukUfmr1NFIMMzWsuMbxiWJZ-y4Ul-CZ8ZVO7Nk4yNdfcfXPoeQtxUrK1aJD7sSU0jBl5xxVjIoszwji6qRUMhasOdkwYDxgjfQXJBXMe4YY1C38JJcAAdWV5ItyN8f3vi50DG6OKOla73Hbvbjgd5iiCnSm7vgR3Oe9T7QLe5xoJsN3Uw9Bpcntzjpo1Gf4RQ_0s_Yuej8VIz6j5t-05_dHY5I9WTpVRpmV7gpzm5Oc2b0QC_zcchPeE1e9HqI-OasS_Lr65eb9fdie_1ts77cFh0IPheVsXxlKm2E1BaNbU0NppWm7kD2qAXIRgCwBtraorQcJbOccwMM-0qIHpbk_ene--AfEsZZjS52OAx6Qp-i4tDylahXOaglWZ3QLvgYA_bqPrhRh4OqmDo2oXbq1IQ6NqEYqCzZ9u68IZkR7ZPpMfoMfDoBmP-5dxhU7BxOHVoXctzKevf_Df8Af3mesg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2392465432</pqid></control><display><type>article</type><title>Robot-assisted Cavectomy Versus Thrombectomy for Level II Inferior Vena Cava Thrombus: Decision-making Scheme and Multi-institutional Analysis</title><source>Elsevier ScienceDirect Journals</source><creator>Shi, Taoping ; Huang, Qingbo ; Liu, Kan ; Du, Songliang ; Fan, Yang ; Yang, Luojia ; Peng, Cheng ; Shen, Dan ; Wang, Zhongxin ; Gao, Yu ; Gu, Liangyou ; Niu, Shaoxi ; Ai, Qing ; Li, Hongzhao ; Liu, Fengyong ; Li, Qiuyang ; Wang, Haiyi ; Guo, Aitao ; Fu, Bin ; Yang, Xiaojian ; Zhang, Xuepei ; Wang, Delin ; Wang, Dongwen ; Guo, Hongqian ; Li, Hengping ; Olivero, Alberto ; Fam, Xeng Inn ; Ma, Xin ; Wang, Baojun ; Zhang, Xu</creator><creatorcontrib>Shi, Taoping ; Huang, Qingbo ; Liu, Kan ; Du, Songliang ; Fan, Yang ; Yang, Luojia ; Peng, Cheng ; Shen, Dan ; Wang, Zhongxin ; Gao, Yu ; Gu, Liangyou ; Niu, Shaoxi ; Ai, Qing ; Li, Hongzhao ; Liu, Fengyong ; Li, Qiuyang ; Wang, Haiyi ; Guo, Aitao ; Fu, Bin ; Yang, Xiaojian ; Zhang, Xuepei ; Wang, Delin ; Wang, Dongwen ; Guo, Hongqian ; Li, Hengping ; Olivero, Alberto ; Fam, Xeng Inn ; Ma, Xin ; Wang, Baojun ; Zhang, Xu</creatorcontrib><description>Robot-assisted thrombectomy (RAT) for inferior vena cava (IVC) thrombus (RAT-IVCT) is being increasingly reported. However, the techniques and indications for robot-assisted cavectomy (RAC) for IVC thrombus are not well described.
To develop a decision-making program and analyze multi-institutional outcomes of RAC-IVCT versus RAT-IVCT.
Ninety patients with renal cell carcinoma (RCC) with level II IVCT were included from eight Chinese urological centers, and underwent RAC-IVCT (30 patients) or RAT-IVCT (60 patients) from June 2013 to January 2019.
The surgical strategy was based on IVCT imaging characteristics. RAT-IVCT was performed with standardized cavotomy, thrombectomy, and IVC reconstruction. RAC-IVCT was mainly performed in patients with extensive IVC wall invasion when the collateral blood vessels were well-established. For right-sided RCC, the IVC from the infrarenal vein to the infrahepatic veins was stapled. For left-sided RCC, the IVC from the suprarenal vein to the infrahepatic veins was removed and caudal IVC reconstruction was performed to ensure the right renal vein returned through the IVC collaterals.
Clinicopathological, operative, and survival outcomes were collected and analyzed.
All procedures were successfully performed without open conversion. The median operation time (268 vs 190 min) and estimated blood loss (1500 vs 400 ml) were significantly greater for RAC-IVCT versus RAT-IVCT (both p < 0.001). IVC invasion was a risk factor for progression-free and overall survival at midterm follow-up. Large-volume and long-term follow-up studies are needed.
RAC-IVCT or RAT-IVCT represents an alternative minimally invasive approach for selected RCC patients with level II IVCT. Selection of RAC-IVCT or RAT-IVCT is mainly based on preoperative IVCT imaging characteristics, including the presence of IVC wall invasion, the affected kidney, and establishment of the collateral circulation.
In this study we found that robotic surgeries for level II inferior vena cava thrombus were feasible and safe. Preoperative imaging played an important role in establishing an appropriate surgical plan.
Robot-assisted cavectomy (RAC) for inferior vena cava thrombus (IVCT) is safe and feasible in patients with extensive IVC wall invasion if the collateral blood vessels are well established. Selection of RAC or robot-assisted thrombectomy for IVCT can be based on preoperative IVCT imaging characteristics, including the presence of IVC wall invasion, the affected kidney, and establishment of the collateral circulation. IVC invasion and tumor grade were independent risk factors for progression-free survival, while body mass index, tumor type and grade, perirenal fat invasion, and lymph node metastasis were independent risk factors for overall survival.</description><identifier>ISSN: 0302-2838</identifier><identifier>EISSN: 1873-7560</identifier><identifier>DOI: 10.1016/j.eururo.2020.03.020</identifier><identifier>PMID: 32305170</identifier><language>eng</language><publisher>Switzerland: Elsevier B.V</publisher><subject>Inferior vena cava ; Laparoscopy ; Nephrectomy ; Renal cell carcinoma ; Robotics ; Thrombus ; Vascular resection</subject><ispartof>European urology, 2020-10, Vol.78 (4), p.592-602</ispartof><rights>2020</rights><rights>Copyright © 2020. Published by Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-1bd24b1ab67adebd9b53b97b5c37fea637863308395de7d2e70d222b30ef166f3</citedby><orcidid>0000-0002-0717-1748</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0302283820301950$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32305170$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shi, Taoping</creatorcontrib><creatorcontrib>Huang, Qingbo</creatorcontrib><creatorcontrib>Liu, Kan</creatorcontrib><creatorcontrib>Du, Songliang</creatorcontrib><creatorcontrib>Fan, Yang</creatorcontrib><creatorcontrib>Yang, Luojia</creatorcontrib><creatorcontrib>Peng, Cheng</creatorcontrib><creatorcontrib>Shen, Dan</creatorcontrib><creatorcontrib>Wang, Zhongxin</creatorcontrib><creatorcontrib>Gao, Yu</creatorcontrib><creatorcontrib>Gu, Liangyou</creatorcontrib><creatorcontrib>Niu, Shaoxi</creatorcontrib><creatorcontrib>Ai, Qing</creatorcontrib><creatorcontrib>Li, Hongzhao</creatorcontrib><creatorcontrib>Liu, Fengyong</creatorcontrib><creatorcontrib>Li, Qiuyang</creatorcontrib><creatorcontrib>Wang, Haiyi</creatorcontrib><creatorcontrib>Guo, Aitao</creatorcontrib><creatorcontrib>Fu, Bin</creatorcontrib><creatorcontrib>Yang, Xiaojian</creatorcontrib><creatorcontrib>Zhang, Xuepei</creatorcontrib><creatorcontrib>Wang, Delin</creatorcontrib><creatorcontrib>Wang, Dongwen</creatorcontrib><creatorcontrib>Guo, Hongqian</creatorcontrib><creatorcontrib>Li, Hengping</creatorcontrib><creatorcontrib>Olivero, Alberto</creatorcontrib><creatorcontrib>Fam, Xeng Inn</creatorcontrib><creatorcontrib>Ma, Xin</creatorcontrib><creatorcontrib>Wang, Baojun</creatorcontrib><creatorcontrib>Zhang, Xu</creatorcontrib><title>Robot-assisted Cavectomy Versus Thrombectomy for Level II Inferior Vena Cava Thrombus: Decision-making Scheme and Multi-institutional Analysis</title><title>European urology</title><addtitle>Eur Urol</addtitle><description>Robot-assisted thrombectomy (RAT) for inferior vena cava (IVC) thrombus (RAT-IVCT) is being increasingly reported. However, the techniques and indications for robot-assisted cavectomy (RAC) for IVC thrombus are not well described.
To develop a decision-making program and analyze multi-institutional outcomes of RAC-IVCT versus RAT-IVCT.
Ninety patients with renal cell carcinoma (RCC) with level II IVCT were included from eight Chinese urological centers, and underwent RAC-IVCT (30 patients) or RAT-IVCT (60 patients) from June 2013 to January 2019.
The surgical strategy was based on IVCT imaging characteristics. RAT-IVCT was performed with standardized cavotomy, thrombectomy, and IVC reconstruction. RAC-IVCT was mainly performed in patients with extensive IVC wall invasion when the collateral blood vessels were well-established. For right-sided RCC, the IVC from the infrarenal vein to the infrahepatic veins was stapled. For left-sided RCC, the IVC from the suprarenal vein to the infrahepatic veins was removed and caudal IVC reconstruction was performed to ensure the right renal vein returned through the IVC collaterals.
Clinicopathological, operative, and survival outcomes were collected and analyzed.
All procedures were successfully performed without open conversion. The median operation time (268 vs 190 min) and estimated blood loss (1500 vs 400 ml) were significantly greater for RAC-IVCT versus RAT-IVCT (both p < 0.001). IVC invasion was a risk factor for progression-free and overall survival at midterm follow-up. Large-volume and long-term follow-up studies are needed.
RAC-IVCT or RAT-IVCT represents an alternative minimally invasive approach for selected RCC patients with level II IVCT. Selection of RAC-IVCT or RAT-IVCT is mainly based on preoperative IVCT imaging characteristics, including the presence of IVC wall invasion, the affected kidney, and establishment of the collateral circulation.
In this study we found that robotic surgeries for level II inferior vena cava thrombus were feasible and safe. Preoperative imaging played an important role in establishing an appropriate surgical plan.
Robot-assisted cavectomy (RAC) for inferior vena cava thrombus (IVCT) is safe and feasible in patients with extensive IVC wall invasion if the collateral blood vessels are well established. Selection of RAC or robot-assisted thrombectomy for IVCT can be based on preoperative IVCT imaging characteristics, including the presence of IVC wall invasion, the affected kidney, and establishment of the collateral circulation. IVC invasion and tumor grade were independent risk factors for progression-free survival, while body mass index, tumor type and grade, perirenal fat invasion, and lymph node metastasis were independent risk factors for overall survival.</description><subject>Inferior vena cava</subject><subject>Laparoscopy</subject><subject>Nephrectomy</subject><subject>Renal cell carcinoma</subject><subject>Robotics</subject><subject>Thrombus</subject><subject>Vascular resection</subject><issn>0302-2838</issn><issn>1873-7560</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kc2O0zAUhS0EYkrhDRDykk2C49vYCQukUfmr1NFIMMzWsuMbxiWJZ-y4Ul-CZ8ZVO7Nk4yNdfcfXPoeQtxUrK1aJD7sSU0jBl5xxVjIoszwji6qRUMhasOdkwYDxgjfQXJBXMe4YY1C38JJcAAdWV5ItyN8f3vi50DG6OKOla73Hbvbjgd5iiCnSm7vgR3Oe9T7QLe5xoJsN3Uw9Bpcntzjpo1Gf4RQ_0s_Yuej8VIz6j5t-05_dHY5I9WTpVRpmV7gpzm5Oc2b0QC_zcchPeE1e9HqI-OasS_Lr65eb9fdie_1ts77cFh0IPheVsXxlKm2E1BaNbU0NppWm7kD2qAXIRgCwBtraorQcJbOccwMM-0qIHpbk_ene--AfEsZZjS52OAx6Qp-i4tDylahXOaglWZ3QLvgYA_bqPrhRh4OqmDo2oXbq1IQ6NqEYqCzZ9u68IZkR7ZPpMfoMfDoBmP-5dxhU7BxOHVoXctzKevf_Df8Af3mesg</recordid><startdate>202010</startdate><enddate>202010</enddate><creator>Shi, Taoping</creator><creator>Huang, Qingbo</creator><creator>Liu, Kan</creator><creator>Du, Songliang</creator><creator>Fan, Yang</creator><creator>Yang, Luojia</creator><creator>Peng, Cheng</creator><creator>Shen, Dan</creator><creator>Wang, Zhongxin</creator><creator>Gao, Yu</creator><creator>Gu, Liangyou</creator><creator>Niu, Shaoxi</creator><creator>Ai, Qing</creator><creator>Li, Hongzhao</creator><creator>Liu, Fengyong</creator><creator>Li, Qiuyang</creator><creator>Wang, Haiyi</creator><creator>Guo, Aitao</creator><creator>Fu, Bin</creator><creator>Yang, Xiaojian</creator><creator>Zhang, Xuepei</creator><creator>Wang, Delin</creator><creator>Wang, Dongwen</creator><creator>Guo, Hongqian</creator><creator>Li, Hengping</creator><creator>Olivero, Alberto</creator><creator>Fam, Xeng Inn</creator><creator>Ma, Xin</creator><creator>Wang, Baojun</creator><creator>Zhang, Xu</creator><general>Elsevier B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0717-1748</orcidid></search><sort><creationdate>202010</creationdate><title>Robot-assisted Cavectomy Versus Thrombectomy for Level II Inferior Vena Cava Thrombus: Decision-making Scheme and Multi-institutional Analysis</title><author>Shi, Taoping ; Huang, Qingbo ; Liu, Kan ; Du, Songliang ; Fan, Yang ; Yang, Luojia ; Peng, Cheng ; Shen, Dan ; Wang, Zhongxin ; Gao, Yu ; Gu, Liangyou ; Niu, Shaoxi ; Ai, Qing ; Li, Hongzhao ; Liu, Fengyong ; Li, Qiuyang ; Wang, Haiyi ; Guo, Aitao ; Fu, Bin ; Yang, Xiaojian ; Zhang, Xuepei ; Wang, Delin ; Wang, Dongwen ; Guo, Hongqian ; Li, Hengping ; Olivero, Alberto ; Fam, Xeng Inn ; Ma, Xin ; Wang, Baojun ; Zhang, Xu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-1bd24b1ab67adebd9b53b97b5c37fea637863308395de7d2e70d222b30ef166f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Inferior vena cava</topic><topic>Laparoscopy</topic><topic>Nephrectomy</topic><topic>Renal cell carcinoma</topic><topic>Robotics</topic><topic>Thrombus</topic><topic>Vascular resection</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shi, Taoping</creatorcontrib><creatorcontrib>Huang, Qingbo</creatorcontrib><creatorcontrib>Liu, Kan</creatorcontrib><creatorcontrib>Du, Songliang</creatorcontrib><creatorcontrib>Fan, Yang</creatorcontrib><creatorcontrib>Yang, Luojia</creatorcontrib><creatorcontrib>Peng, Cheng</creatorcontrib><creatorcontrib>Shen, Dan</creatorcontrib><creatorcontrib>Wang, Zhongxin</creatorcontrib><creatorcontrib>Gao, Yu</creatorcontrib><creatorcontrib>Gu, Liangyou</creatorcontrib><creatorcontrib>Niu, Shaoxi</creatorcontrib><creatorcontrib>Ai, Qing</creatorcontrib><creatorcontrib>Li, Hongzhao</creatorcontrib><creatorcontrib>Liu, Fengyong</creatorcontrib><creatorcontrib>Li, Qiuyang</creatorcontrib><creatorcontrib>Wang, Haiyi</creatorcontrib><creatorcontrib>Guo, Aitao</creatorcontrib><creatorcontrib>Fu, Bin</creatorcontrib><creatorcontrib>Yang, Xiaojian</creatorcontrib><creatorcontrib>Zhang, Xuepei</creatorcontrib><creatorcontrib>Wang, Delin</creatorcontrib><creatorcontrib>Wang, Dongwen</creatorcontrib><creatorcontrib>Guo, Hongqian</creatorcontrib><creatorcontrib>Li, Hengping</creatorcontrib><creatorcontrib>Olivero, Alberto</creatorcontrib><creatorcontrib>Fam, Xeng Inn</creatorcontrib><creatorcontrib>Ma, Xin</creatorcontrib><creatorcontrib>Wang, Baojun</creatorcontrib><creatorcontrib>Zhang, Xu</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shi, Taoping</au><au>Huang, Qingbo</au><au>Liu, Kan</au><au>Du, Songliang</au><au>Fan, Yang</au><au>Yang, Luojia</au><au>Peng, Cheng</au><au>Shen, Dan</au><au>Wang, Zhongxin</au><au>Gao, Yu</au><au>Gu, Liangyou</au><au>Niu, Shaoxi</au><au>Ai, Qing</au><au>Li, Hongzhao</au><au>Liu, Fengyong</au><au>Li, Qiuyang</au><au>Wang, Haiyi</au><au>Guo, Aitao</au><au>Fu, Bin</au><au>Yang, Xiaojian</au><au>Zhang, Xuepei</au><au>Wang, Delin</au><au>Wang, Dongwen</au><au>Guo, Hongqian</au><au>Li, Hengping</au><au>Olivero, Alberto</au><au>Fam, Xeng Inn</au><au>Ma, Xin</au><au>Wang, Baojun</au><au>Zhang, Xu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Robot-assisted Cavectomy Versus Thrombectomy for Level II Inferior Vena Cava Thrombus: Decision-making Scheme and Multi-institutional Analysis</atitle><jtitle>European urology</jtitle><addtitle>Eur Urol</addtitle><date>2020-10</date><risdate>2020</risdate><volume>78</volume><issue>4</issue><spage>592</spage><epage>602</epage><pages>592-602</pages><issn>0302-2838</issn><eissn>1873-7560</eissn><abstract>Robot-assisted thrombectomy (RAT) for inferior vena cava (IVC) thrombus (RAT-IVCT) is being increasingly reported. However, the techniques and indications for robot-assisted cavectomy (RAC) for IVC thrombus are not well described.
To develop a decision-making program and analyze multi-institutional outcomes of RAC-IVCT versus RAT-IVCT.
Ninety patients with renal cell carcinoma (RCC) with level II IVCT were included from eight Chinese urological centers, and underwent RAC-IVCT (30 patients) or RAT-IVCT (60 patients) from June 2013 to January 2019.
The surgical strategy was based on IVCT imaging characteristics. RAT-IVCT was performed with standardized cavotomy, thrombectomy, and IVC reconstruction. RAC-IVCT was mainly performed in patients with extensive IVC wall invasion when the collateral blood vessels were well-established. For right-sided RCC, the IVC from the infrarenal vein to the infrahepatic veins was stapled. For left-sided RCC, the IVC from the suprarenal vein to the infrahepatic veins was removed and caudal IVC reconstruction was performed to ensure the right renal vein returned through the IVC collaterals.
Clinicopathological, operative, and survival outcomes were collected and analyzed.
All procedures were successfully performed without open conversion. The median operation time (268 vs 190 min) and estimated blood loss (1500 vs 400 ml) were significantly greater for RAC-IVCT versus RAT-IVCT (both p < 0.001). IVC invasion was a risk factor for progression-free and overall survival at midterm follow-up. Large-volume and long-term follow-up studies are needed.
RAC-IVCT or RAT-IVCT represents an alternative minimally invasive approach for selected RCC patients with level II IVCT. Selection of RAC-IVCT or RAT-IVCT is mainly based on preoperative IVCT imaging characteristics, including the presence of IVC wall invasion, the affected kidney, and establishment of the collateral circulation.
In this study we found that robotic surgeries for level II inferior vena cava thrombus were feasible and safe. Preoperative imaging played an important role in establishing an appropriate surgical plan.
Robot-assisted cavectomy (RAC) for inferior vena cava thrombus (IVCT) is safe and feasible in patients with extensive IVC wall invasion if the collateral blood vessels are well established. Selection of RAC or robot-assisted thrombectomy for IVCT can be based on preoperative IVCT imaging characteristics, including the presence of IVC wall invasion, the affected kidney, and establishment of the collateral circulation. IVC invasion and tumor grade were independent risk factors for progression-free survival, while body mass index, tumor type and grade, perirenal fat invasion, and lymph node metastasis were independent risk factors for overall survival.</abstract><cop>Switzerland</cop><pub>Elsevier B.V</pub><pmid>32305170</pmid><doi>10.1016/j.eururo.2020.03.020</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-0717-1748</orcidid></addata></record> |
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| ispartof | European urology, 2020-10, Vol.78 (4), p.592-602 |
| issn | 0302-2838 1873-7560 |
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| source | Elsevier ScienceDirect Journals |
| subjects | Inferior vena cava Laparoscopy Nephrectomy Renal cell carcinoma Robotics Thrombus Vascular resection |
| title | Robot-assisted Cavectomy Versus Thrombectomy for Level II Inferior Vena Cava Thrombus: Decision-making Scheme and Multi-institutional Analysis |
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