Initial experience in robot-associated radical nephrectomy with inferior vena cava tumor thrombectomy

Kojiro Ohba; Kensuke Mitsunari; Hiromi Nakanishi; Takuji Yasuda; Yuichiro Nakamura; Tomohiro Matsuo; Yasushi Mochizuki; Ryoichi Imamura

doi:10.21037/tcr-23-862

Initial experience in robot-associated radical nephrectomy with inferior vena cava tumor thrombectomy

Transl Cancer Res. 2023 Dec 31;12(12):3425-3431. doi: 10.21037/tcr-23-862. Epub 2023 Dec 3.

Authors

Kojiro Ohba¹, Kensuke Mitsunari², Hiromi Nakanishi¹, Takuji Yasuda², Yuichiro Nakamura², Tomohiro Matsuo², Yasushi Mochizuki², Ryoichi Imamura¹

Affiliations

¹ Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
² Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan.

Abstract

Background: Renal cell carcinoma (RCC) is often locally invasive and may extend from the renal vein into the inferior vena cava (IVC) as a venous tumor thrombus (VTT). Radical nephrectomy with IVC tumor thrombectomy (IVC-TT) via an open approach has been shown to carry high morbidity and mortality. Recently, robot-associated radical nephrectomy (RARN) has been developed with the aim of improving the performance and outcomes of surgery for RCC with IVC-VTT.

Methods: We here present four patients who had right RCC with IVC-VTT and underwent RARN with IVC-TT in Nagasaki University Hospital. All four patients had level II IVC-TT and underwent RARN with IVC-TT using a da Vinci Xi surgical system. The procedure comprised performing the Kocher maneuver, exposing the right renal artery in the aortocaval region dorsal to the left renal vein, exposing, mobilizing, and clipping the IVC, clamping and incising the IVC, and removing the kidney with the VTT en bloc.

Results: The mean tumor size was 83.1 (range, 50.1-115.2) mm and the mean length of the VTT within the IVC 41.6 (range, 25.3-44.3) mm. The mean console time was 290 (range, 287-367) minutes and the mean blood loss was 200 (range, 175-260) mL and no patient required blood transfusion.

Conclusions: Our initial experience of the procedure of RARN with IVC-TT for level II IVC-VTT is that it is safe and has acceptable perioperative outcomes and complications.

Keywords: Renal cell carcinoma (RCC); inferior vena cava tumor thrombectomy (IVC-TT); robot-associated radical nephrectomy (RARN); venous tumor thrombus (VTT).