Renal cell carcinoma with segmental renal vein invasion:diagnostic challenges and short-term outcomes of robot-assisted laparoscopic partial nephrectomy
10.3969/j.issn.1009-8291.2025.11.005
- VernacularTitle:伴肾静脉属支侵犯的肾细胞癌:诊断的挑战及机器人辅助腹腔镜下肾部分切除术短期疗效
- Author:
Xiangpeng ZOU
1
;
Cheng LUO
;
Shaohan YIN
;
Li TIAN
;
Ping YANG
;
Zhiling ZHANG
Author Information
1. 中山大学肿瘤防治中心,华南恶性肿瘤防治全国重点实验室,肿瘤医学协同创新中心泌尿外科,广东 广州 510060
- Publication Type:Journal Article
- Keywords:
renal cell carcinoma;
renal vein invasion;
partial nephrectomy;
robotics assistance
- From:
Journal of Modern Urology
2025;30(11):932-937
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the short-term outcomes of robot-assisted partial nephrectomy(RAPN)in the treatment of renal cell carcinoma(RCC)involving segmental renal vein invasion,and to summarize relevant diagnostic experience and surgical techniques.Methods A retrospective analysis was conducted on the clinicopathological data of 23 RCC patients who were found to have segmental renal vein invasion during RAPN at Sun Yat-sen University Cancer Center during 2022 and 2024.All procedures were performed by the same experienced urologic surgeon(＞1000 robotic cases).Preoperative computed tomography(CT)scans of all patients failed to reveal segmental renal vein invasion.Two experienced radiologists re-evaluated the imaging postoperatively.The clinical and pathological data of patients were analyzed to preliminarily explore the short-term efficacy,imaging,intraoperative findings and pathological characteristics.Results All surgeries were completed successfully via the transperitoneal approach with renal preservation.The median operation time was 151.0(125.5,182.0)min,and median blood loss was 180.0(100.0,300.0)mL;2 patients(8.7％)required intraoperative transfusion;3(13.0％)experienced postoperative complications,all of which were minor(Clavien-Dindo grade 1-2).Postoperative pathology confirmed venous invasion in 2 patients.The diagnostic rates of segmental renal vein invasion by the two radiologists were 47.8％(11/23)and 21.7％(5/23),respectively,with concordance in only 3 cases.During a mean follow-up of 9.1 months,1 patient developed iliac lymph node metastasis without local recurrence 12.4 months after surgery.After reoperation to remove the metastatic focus,the patient was treated with Axitinib combined with Toripalimab and has survived to date.The remaining patients were followed up for an average of 8.9 months,with no recurrence or metastasis observed.Conclusion Preoperative detection of segmental renal vein invasion in RCC is challenging,and pathological confirmation is often inconsistent with intraoperative findings.For RCC patients with intraoperatively identified segmental renal vein invasion,RAPN performed by experienced surgeons is feasible and safe on the premise of ensuring complete tumor resection,with favorable short-term oncologic outcomes.Long-term results require further follow-up.
