Robotic surgical management of renal tumours with caval thrombosis: A comprehensive analysis and outcomes in a case series using minimally invasive approaches

IF 0.2 4区医学 Q4 SURGERY

Surgical Practice Pub Date : 2025-02-09 DOI:10.1111/1744-1633.70000

Jacopo Durante MD, Francesca Manassero PhD, Michele Santarsieri MD, Girolamo Fiorini MD, Pagni Riccardo MD, Andrea Colli, Piero Lippolis MD, Giorgio Pomara PhD

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引用次数: 0

Abstract

Introduction

Since the 1970s, the surgical treatment of renal tumors with caval thrombosis has been a complex challenge. The advent of robot-assisted nephrectomy with tumor thrombectomy has revolutionized this field. This case series aims to report the outcomes of an unselected population of Renal Cell Carcinoma (RCC) with complex caval thrombosis treated robotically at our center.

Methods

We established a database for RCC cases with inferior vena cava (IVC) thrombectomy, including five patients treated between October 2022 and October 2023. A notable aspect of our methodology was the incorporation of the AngioVac system for the management of a level IV thrombus facilitating a minimally invasive approach without the need for a thoracic approach.

Results

All patients underwent successful robotic surgery without conversion to open surgery. There were one pT3a, 3 pT3b and one pT3c tumors, 3 on the right side and 2 on the left, the upper level of the thrombus was II in one patient, III in 3 and IV in one. The average surgery duration was 414 ± 120.95 minutes, and the average blood loss was 400 ± 393, 70 cc. The mean IVC occlusion time was 20.6 ± 6.50 minutes. We did not observe any statistically significant differences between the preoperative hemoglobin values (12.14 ± 1.39) and the postoperative values (9.88 ± 0.96), nor between preoperative creatinine levels (2.00 ± 2.11) and postoperative levels (2.20 ± 2.00). The average length of hospital stay was 7 ± 2 days. We observed only 2 Clavien-Dindo grade 2 events. The follow-up period, updated for the last patient, is 12 months.

Conclusions

This case series demonstrates the viability and safety of robotic surgery in treating RCC with complex caval thrombosis. While the study is limited by the small number of cases, these results contribute to the growing body of evidence supporting robotic surgery in complex renal tumors.

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机器人手术治疗肾肿瘤伴腔静脉血栓形成：采用微创方法的病例系列的综合分析和结果

自20世纪70年代以来，伴有腔静脉血栓形成的肾肿瘤的手术治疗一直是一个复杂的挑战。机器人辅助肾切除术和肿瘤血栓切除术的出现彻底改变了这一领域。本病例系列旨在报告未选择的肾细胞癌（RCC）合并复杂腔静脉血栓在我们中心进行机器人治疗的结果。方法建立下腔静脉（IVC）取栓的RCC病例数据库，包括5例于2022年10月至2023年10月期间接受治疗的患者。我们方法的一个值得注意的方面是将AngioVac系统用于IV级血栓的治疗，这有助于在不需要胸部入路的情况下进行微创入路。结果所有患者均顺利完成机器人手术，未转开腹手术。pT3a肿瘤1例，pT3b肿瘤3例，pT3c肿瘤1例，右侧肿瘤3例，左侧肿瘤2例，血栓上部1例为II级，3例为III级，1例为IV级。平均手术时间414±120.95 min，平均出血量400±393,70 cc，平均下腔静脉闭塞时间20.6±6.50 min。术前血红蛋白值（12.14±1.39）与术后血红蛋白值（9.88±0.96）、术前肌酐值（2.00±2.11）与术后肌酐值（2.20±2.00）无统计学差异。平均住院时间为7±2天。我们只观察到2例Clavien-Dindo 2级事件。最后一位患者的随访期为12个月。结论：本病例系列证明了机器人手术治疗RCC合并复杂腔静脉血栓的可行性和安全性。虽然这项研究受到少数病例的限制，但这些结果有助于越来越多的证据支持机器人手术治疗复杂的肾脏肿瘤。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Practice 医学-外科

CiteScore

0.90

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Surgical Practice is a peer-reviewed quarterly journal, which is dedicated to the art and science of advances in clinical practice and research in surgery. Surgical Practice publishes papers in all fields of surgery and surgery-related disciplines. It consists of sections of history, leading articles, reviews, original papers, discussion papers, education, case reports, short notes on surgical techniques and letters to the Editor.