Abstract
Objective
To provide insight into the surgical and oncological outcomes of robotic, laparoscopic and open radical nephrectomy with venous thrombectomy (RALRN-VT, LRN-VT, ORN-VT) in patients with renal tumor and venous thrombus.
Materials and Methods
A propensity-matched retrospective cohort study containing 324 patients with renal tumor and venous thrombus from January 2014 to August 2021 was analyzed. We compared surgical outcomes and we used the Kalan-Meier method to assess the overall survival (OS), tumor-specific survival (TSS), metastasis-free survival (MFS) and local recurrence-free survival (LRFS). The Pearson chi-square test and Fisher exact test, Wilcoxon rank sum test, Cox proportional hazards regression model and log-rank test were used.
Results
After matching, baseline characteristics were comparable in the RALRN-VT, LRN-VT and ORN-VT group. The RALRN-VT group had the least operative time (median 134 min vs 289 min vs 330 min, P < 0.001), the least blood loss (median 250 ml vs 500 ml vs 1000 ml, P < 0.001) and the fewest packed red blood cells transfusion (median 400 ml vs 800 ml vs 1200 ml, P < 0.001). The ORN-VT group had the highest complication rate (18.2 vs 22.7 vs 43.2%, P = 0.005), the highest Clavien grade (P = 0.001) and the longest postoperative hospital stay (median 7d vs 8d vs 10d, P < 0.001). No significant difference in OS, TSS and MFS between the minimally invasive procedures (MIP, including RALRN-VT and LRN-VT) group and ORN-VT group was found. The hazard ratio of LRFS for the MIP group was 0.20 (95% CI 0.06–0.70, P = 0.01) compared with ORN-VT group.
Conclusions
RALRN-VT can result in the best surgical outcomes compared with LRN-VT and ORN-VT. The MIP group had a better LRFS compared with ORN-VT group.
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References
Disanto V, Pansadoro V, Portoghese F et al (2005) Retroperitoneal laparoscopic radical nephrectomy for renal cell carcinoma with infrahepatic vena caval thrombus. Eur Urol 47(3):352–356. https://doi.org/10.1016/j.eururo.2004.11.010
Shao P, Li J, Qin C et al (2015) Laparoscopic radical nephrectomy and inferior vena cava thrombectomy in the treatment of renal cell carcinoma. Eur Urol 68(1):115–122. https://doi.org/10.1016/j.eururo.2014.12.011
Chandru P, Landman J, Joseph OH (2002) Hand assisted laparoscopy radical nephrectomy for renal cell carcinoma with inderior vena cava thrombus. J Urol 168:176–179
Tian X, Hong P, Liu Z et al (2020) En bloc retroperitoneal laparoscopic radical nephrectomy with inferior vena cava thrombectomy for renal cell carcinoma with level 0 to II venous tumor thrombus: a single-center experience. Cancer 126(9):2073–2078
Varkarakis IM, Bhayani SB, Allaf ME et al (2004) Laparoscopic-assisted nephrectomy with inferior vena cava tumor thrombectomy: preliminary results. Urology 64(5):925–929. https://doi.org/10.1016/j.urology.2004.05.044
Bansal RK, Tu HY, Drachenberg D et al (2014) Laparoscopic management of advanced renal cell carcinoma with renal vein and inferior vena cava thrombus. Urology 83(4):812–816. https://doi.org/10.1016/j.urology.2013.09.060
Abaza R (2011) Initial series of robotic radical nephrectomy with vena caval tumor thrombectomy. Eur Urol 59(4):652–656. https://doi.org/10.1016/j.eururo.2010.08.038
Desai MM, Gill IS, Ramani AP et al (2003) Laparoscopic radical nephrectomy for cancer with level I renal vein involvement. J Urol 169(2):487–491. https://doi.org/10.1097/01.ju.0000041955.93458.f5
Rose KM, Navaratnam AK, Faraj KS et al (2020) Comparison of open and robot assisted radical nephrectomy with level i and ii inferior vena cava tumor thrombus: the mayo clinic experience. Urology 136:152–157. https://doi.org/10.1016/j.urology.2019.11.002
Gu L, Ma X, Gao Y et al (2017) Robotic versus open level i-ii inferior vena cava thrombectomy: a matched group comparative analysis. J Urol 198(6):1241–1246. https://doi.org/10.1016/j.juro.2017.06.094
Liu Z, Tang S, Tian X et al (2019) Foley catheter-assisted six-step thrombectomy technique in the surgical management of renal cell carcinoma with Mayo level II to IV tumor thrombus. J Int Med Res 47(5):2104–2115. https://doi.org/10.1177/0300060519836912
Liu Z, Zhao X, Ge L et al (2020) Completely laparoscopic versus open radical nephrectomy and infrahepatic tumor thrombectomy: Comparison of surgical complexity and prognosis. Asian J Surg. https://doi.org/10.1016/j.asjsur.2020.12.003
Liu Z, Zhang L, Hong P et al (2020) The influence of venous tumor thrombus combined with bland thrombus on the surgical treatment and prognosis of renal cell carcinoma patients. Cancer Med 9(16):5860–5868. https://doi.org/10.1002/cam4.3264
Hackett NJ, De Oliveira GS, Jain UK et al (2015) ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg 18:184–190. https://doi.org/10.1016/j.ijsu.2015.04.079
Mitropoulos D, Artibani W, Graefen M et al (2012) Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol 61(2):341–349. https://doi.org/10.1016/j.eururo.2011.10.033
Blute ML, Leibovich BC, Lohse CM et al (2004) The Mayo clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int 94(1):33–41. https://doi.org/10.1111/j.1464-410X.2004.04897.x
Haferkamp A, Bastian PJ, Jakobi H et al (2007) Renal cell carcinoma with tumor thrombus extension into the vena cava: prospective long-term followup. J Urol 177(5):1703–1708. https://doi.org/10.1016/j.juro.2007.01.039
Ljungberg B, Bensalah K, Canfield S et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67(5):913–924. https://doi.org/10.1016/j.eururo.2015.01.005
Ljungberg B, Albiges L, Abu-Ghanem Y et al (2019) European association of urology guidelines on renal cell carcinoma: the 2019 update. Eur Urol 75(5):799–810. https://doi.org/10.1016/j.eururo.2019.02.011
Ficarra V, Novara G, Martignoni G (2009) The use of simplified versions of the Fuhrman nuclear grading system in clinical practice requires the agreement of a multidisciplinary panel of experts. Eur Urol 56(5):782–784
Chopra S, Simone G, Metcalfe C et al (2017) Robot-assisted level II-III inferior vena cava tumor thrombectomy: step-by-step technique and 1 year outcomes. Eur Urol 72(2):267–274. https://doi.org/10.1016/j.eururo.2016.08.066
Gill IS, Metcalfe C, Abreu A et al (2015) Robotic level III inferior vena cava tumor thrombectomy: initial series. J Urol 194(4):929–938. https://doi.org/10.1016/j.juro.2015.03.119
Abaza R, Shabsigh A, Castle E et al (2016) Multi-institutional experience with robotic nephrectomy with inferior vena cava tumor thrombectomy. J Urol 195(4 Pt 1):865–871. https://doi.org/10.1016/j.juro.2015.09.094
Wang B, Huang Q, Liu K et al (2020) Robot-assisted Level III-IV inferior vena cava thrombectomy: initial series with step-by-step procedures and 1 year outcomes. Eur Urol 78(1):77–86. https://doi.org/10.1016/j.eururo.2019.04.019
Xu B, Zhao Q, Jin J et al (2014) Laparoscopic versus open surgery for renal masses with infrahepatic tumor thrombus: the largest series of retroperitoneal experience from China. J Endourol 28(2):201–207. https://doi.org/10.1089/end.2013.0519
Ebbing J, Wiebach T, Kempkensteffen C et al (2015) Evaluation of perioperative complications in open and laparoscopic surgery for renal cell cancer with tumor thrombus involvement using the clavien-dindo classification. Eur J Surg Oncol 41(7):941–952. https://doi.org/10.1016/j.ejso.2015.02.009
Acknowledgements
We thank all the staff of department of urology in the Peking University Third Hospital. We also thank Mr. JiaJu Huang, who was the founder of BEYOND band. His music has inspired us to pursue the truth, freedom and essential nature of science in the past twenty years.
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National Nature Science Foundation of China (81972381).
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YZ Study design/Project development/Data analysis/Manuscript writing-original draft, HB Manuscript writing-reviewing/Project development/Critical revision YY Manuscript writing-reviewing/Project development/Critical revision, ZL Data collection/Supervision, GW Supervision, YS Material support SZ Supervision/Critical revision, CL Supervision/Critical revision, LLM Study design/Supervision/ Critical revision/ Material support/Funding acquision.
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Zhang, Y., Bi, H., Yan, Y. et al. Comparative analysis of surgical and oncologic outcomes of robotic, laparoscopic and open radical nephrectomy with venous thrombectomy: a propensity-matched cohort study. Int J Clin Oncol 28, 145–154 (2023). https://doi.org/10.1007/s10147-022-02265-y
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DOI: https://doi.org/10.1007/s10147-022-02265-y