Since the first report of robotic nephrectomy in the setting of renal tumors with inferior vena cava tumor thrombi, limited additional cases have been reported in the literature, but a retrospective study has shown that the procedure is feasible and was performed safely in selected patients.1
For the retrospective study, researchers analyzed data from 32 cases of robotic nephrectomy with inferior vena cava tumor thrombectomy among 9 surgeons at 9 institutions since 2008. Of those, 30 cases were level 2 thrombi and 2 were level 3 thrombi; none were level 1 thrombi. Patients ranged in age from 43 to 81 years with an average body mass index of 30 kg/m2.
Results showed that cross-clamping of the inferior vena cava was required in 24 cases. Only 1 patient had 2 renal veins with 2 caval thrombi and 1 required synthetic path cavoplasty.
No patients required conversion to open surgery or required the procedure to be aborted. Researchers found that 30 patients ambulated by postoperative day 1 and the average hospital stay was 3.2 days.
“This is a complex condition and the complication rate with open surgery is 12% to 47%, depending on the thrombus level, with a mortality rate of 5% to 10%,” explained lead investigator Ronney Abaza, MD, Robotic Surgery Director at OhioHealth Dublin Methodist Hospital.
“Using robotic nephrectomy, our complication rate and lack of mortalities compare reasonably with open series with no grade III to V complications, according to the Clavien system, in any patient, including no deaths.”2
The study also demonstrated that 7 patients experienced distant recurrence at a mean follow-up of 15.4 months, including 4 of the 8 patients who had node-positive disease on postoperative pathological examination.
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“While complications were relatively minor in our series, it is evident that complications are not entirely avoidable. Even with a minimally invasive approach, the surgical management of severe cancers in mostly elderly patients will likely involve complications,” Dr Abaza added. “However, despite the complex and critical nature of these procedures, our series demonstrates favorable outcomes and reproducibility by surgeons with adequate robotic experience.”
- Abaza R, Shabsigh A, Castle E, et al. Multi-institutional experience with robotic nephrectomy with inferior vena cava tumor thrombectomy [published online ahead of print November 18, 2015]. J Urol. doi: 10.1016/j.juro.2015.09.094.
- Removal of complex renal tumors performed safely by robotic surgery in selected patients [news release]. New York, NY: Elsevier Health Sciences; February 7, 2016. http://www.eurekalert.org/pub_releases/2016-02/ehs-roc020716.php. Accessed February 8, 2016.