Robot-assisted Cavectomy Versus Thrombectomy for Level II Inferior Vena Cava Thrombus: Decision-making Scheme and Multi-institutional Analysis

被引：43

作者：

Shi, Taoping ^{[1
]}

Huang, Qingbo ^{[1
]}

Liu, Kan ^{[1
]}

Du, Songliang ^{[1
]}

Fan, Yang ^{[1
]}

Yang, Luojia ^{[1
]}

Peng, Cheng ^{[1
]}

Shen, Dan ^{[1
]}

Wang, Zhongxin ^{[1
]}

Gao, Yu ^{[1
]}

Gu, Liangyou ^{[1
]}

Niu, Shaoxi ^{[1
]}

Ai, Qing ^{[1
]}

Li, Hongzhao ^{[1
]}

Liu, Fengyong ^{[2
]}

Li, Qiuyang ^{[3
]}

Wang, Haiyi ^{[4
]}

Guo, Aitao ^{[5
]}

Fu, Bin ^{[6
]}

Yang, Xiaojian ^{[7
]}

Zhang, Xuepei ^{[8
]}

Wang, Delin ^{[9
]}

Wang, Dongwen ^{[10
]}

Guo, Hongqian ^{[11
]}

Li, Hengping ^{[12
]}

Olivero, Alberto ^{[13
]}

Fam, Xeng Inn ^{[14
]}

Ma, Xin ^{[1
]}

Wang, Baojun ^{[1
]}

Zhang, Xu ^{[1
]}

机构：

[1] Chinese Peoples Liberat Army Gen Hosp, Dept Urol, PLA Med Sch, Beijing, Peoples R China

[2] Chinese Peoples Liberat Army Gen Hosp, Dept Intervent Radiol, Beijing, Peoples R China

[3] Chinese Peoples Liberat Army Gen Hosp, Dept Ultrasound, Beijing, Peoples R China

[4] Chinese Peoples Liberat Army Gen Hosp, Dept Radiol, Beijing, Peoples R China

[5] Chinese Peoples Liberat Army Gen Hosp, Dept Pathol, Beijing, Peoples R China

[6] Nanchang Univ, Affiliated Hosp 1, Dept Urol, Nanchang, Jiangxi, Peoples R China

[7] Chinese PLA Air Force Med Univ, Xijing Hosp, Dept Urol, Xian, Peoples R China

[8] Zhengzhou Univ, Dept Urol, Affiliated Hosp 1, Zhengzhou, Peoples R China

[9] Chongqing Med Univ, Affiliated Hosp 1, Dept Urol, Chongqing, Peoples R China

[10] Shanxi Med Univ, Hosp 1, Dept Urol, Taiyuan, Peoples R China

[11] Nanjing Med Sch, Nanjing Drum Tower Hosp, Dept Urol, Nanjing, Peoples R China

[12] Gansu Prov Hosp, Dept Urol, Lanzhou, Peoples R China

[13] Univ Genoa, San Martino Policlin Hosp, Dept Urol, Genoa, Italy

[14] Univ Kebangsaan Malaysia, Surg Dept, Urol Unit, Med Ctr, Kuala Lumpur, Malaysia

来源：

EUROPEAN UROLOGY | 2020年 / 78卷 / 04期

基金：

中国国家自然科学基金;

关键词：

Robotics; Laparoscopy; Nephrectomy; Renal cell carcinoma; Thrombus; Inferior vena cava; Vascular resection; RENAL-CELL CARCINOMA; RADICAL NEPHRECTOMY; WALL INVASION; RESECTION; COMPLICATIONS; INTERRUPTION; PREDICTION; EXPERIENCE;

D O I：

10.1016/j.eururo.2020.03.020

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background: 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. Objective: To develop a decision-making program and analyze multi-institutional outcomes of RAC-IVCT versus RAT-IVCT. Design, setting, and participants: 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. Surgical procedure: 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. Measurements: Clinicopathological, operative, and survival outcomes were collected and analyzed. Results and limitations: 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. Conclusions: 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. Patient summary: 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. (C) 2020 Published by Elsevier B.V. on behalf of European Association of Urology.

引用

页码：592 / 602

页数：11