[Robot-assisted laparoscopic inferior vena cava segmental resection for renal tumor with tumor thrombus invading the vascular wall].

Abstract

Objective: To evaluate the safety and oncological outcomes of robot-assisted laparoscopic inferior vena cava (IVC) segmental resection in renal tumor with IVC tumor thrombus (IVCTT).

Methods: Clinical data from renal tumor patients undergoing robot-assisted laparoscopic IVC segmental resection at Peking University Third Hospital from Jan. 2021 to Feb. 2025 were retrospectively analyzed. Data collection included baseline demographics, tumor characteristics, perioperative parameters, and follow-up outcomes. Surgical records and pathological reports were retrieved from the electronic medical record system. Continuous variables were presented as median (P₂₅, P₇₅), and categorical variables as frequency (percentage).

Results: Forty-four patients were enrolled. The cohort comprised 31 males and 13 females, with a median age of 62 (55, 68) years. Right-sided tumors were observed in 39 cases and left-sided in 5 cases. Median tumor diameter was 8.1 (6.1, 10.1) cm. Mayo classifications included grade Ⅱ (n=37), Ⅲ (n=6), and Ⅳ (n=1). Neoadjuvant therapy was administered to 23 patients. Seventeen patients were complicated by IVC bland thrombus. Median operative time was 224.0 (167.3, 303.8) min, with intraoperative blood loss of 500.0 (300.0, 850.0) mL. Transfusion was administered to 19 patients, with a median blood transfusion of 800.0 (400.0, 1 200.0) mL. Postoperative complications occurred in 25 cases (56.8%), classified as Clavien-Dindo grade Ⅰ (n=8) and grade Ⅱ (n=17). Procedure-specific complications included deep vein thrombosis (n=6), transfusion-requiring anemia (n=5), lower extremity edema (n=2), and pulmonary embolism (n=2), with no procedure- related mortality. Median postoperative serum creatinine was 116.0 (86.5, 157.5) μmol/L. Pathological examination identified clear cell renal cell carcinoma as the predominant subtype, observed in 34 cases (77.3%). Pathological staging revealed T3b (n=12), T3c (n=29), and T4 (n=3) disease, with nodal involvement (N1) in 8 cases and distant metastasis (M1) in 17. At a median follow-up of 10 months (range: 1-49 months), cancer-specific mortality occurred in 3 patients, while 1 succumbed to other causes. Disease progression included pulmonary metastasis (n=5), hepatic metastasis (n=4), and local recurrence (n=4). Adjuvant therapy regimens comprised targeted-immunotherapy combinations (n=9) and targeted monotherapy (n=18).

Conclusion: Robot-assisted laparoscopic IVC segmental resection achieves precise thrombus removal with confirmed short-term efficacy in renal tumor with IVCTT, though vigilance against vascular complications remains critical.