A modified surgical technique of robot-assisted inferior vena cava thrombectomy for patients with left renal cell carcinoma and tumor emboli: a report of 7 cases eliminating preoperative interventional embolization
10.3969/j.issn.1009-8291.2025.02.007
- VernacularTitle:机器人腹腔镜下左侧肾癌合并癌栓的技术改进:免介入栓塞7例报告（“大家泌尿网”观看手术视频）
- Author:
Shengzheng WANG
1
;
Jinshan CUI
1
;
Zhenhao LI
1
;
Yunlong LIU
1
;
Shuanbao YU
1
;
Yafeng FAN
1
;
Zhaowei ZHU
1
;
Jin TAO
1
;
Xuepei ZHANG
1
Author Information
1. Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
- Publication Type:Journal Article
- Keywords:
renal neoplasm;
left side;
interventional embolization;
inferior vena cava cancerous emboli;
renal artery;
robot-assisted laparoscopy;
radical nephyectomy
- From:
Journal of Modern Urology
2025;30(2):128-132
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To explore the safety and feasibility of the disconnection of the left renal artery preferentially during robot-assisted inferior vena cava (IVC) thrombectomy for patients with left renal cell carcinoma and tumor emboli. Methods: Clinical data of 7 patients who underwent robot-assisted IVC thrombectomy and radical nephrectomy in the First Affiliated Hospital of Zhengzhou University during Dec.2021 and Oct.2024 were retrospectively analyzed.Thrombectomy was performed first，followed by nephrectomy. The “IVC-first, kidney-last”robotic technique was developed to minimize chances of IVC thrombus. When patients in left lateral decubitus position, the left renal artery was severed from the right side through the inferior vena cava and abdominal aorta. After removal of thrombus from IVC was completed, patients changed to the right lateral position to complete radical left nephrectomy. Results: Imaging examinations revealed that the median diameter of the renal cell carcinomas was 83(46-99) mm; the median length of the inferior vena cava cancerous emboli was 49(2-91) mm.According to the Mayo classification，the cancerous emboli were gradeⅠ in 2 cases，gradeⅡ in 4 cases，and grade Ⅲ in 1 case.All surgeries were successful.The median operation time was 248(201-331) minutes，blood loss 500(200-1000) mL，and 6 cases required intraoperative blood transfusion.The median time for transition into the intensive care unit was 1(1-4) days，and drainage tube removal 6(5-12) days.Serum creatinine increased significantly in 5 cases，4 of which returned to normal after 1 week，but 1 had renal insufficiency (creatinine 166 μmol/L).Chylous fistula occurred in 1 patient，and lower extremity venous thrombosis developed in 3 patients.Pathological examinations indicated 6 cases of renal cell carcinoma and 1 case of MiT family translocation renal cell carcinoma.During the median follow-up of 17(1-35) months，5 cases were tumor-free，while 2 had lung and retroperitoneal metastases.They received targeted therapy of axitinib combined immunotheraphy and lived with tumors. Conclusion: In the left lateral position for left renal cell carcinoma with cancerous emboli，robot-assisted laparoscopic thrombectomy by crossing the inferior vena cava and abdominal aorta and disconnecting the left renal artery first is safe and feasible.
