Presentation Authors: Umberto Anceschi*, roma, Italy, Gabriele Tuderti, Aldo Brassetti, Maria Consiglia Ferriero, Francesco Minisola, Manuela Costantini, Salvatore Guaglianone, Rocco Simone Flammia, Riccardo Mastroianni, Michele Gallucci, Giuseppe Simone, Rome, Italy
Introduction: Radical nephrectomy with Inferior vena cava (IVC) thrombectomy for renal cancer represents one of the most challenging urologic surgical procedures. The aims of this series are to detail the surgical technique and to report perioperative and oncologic outcomes of 30 consecutive cases of completely intracorporeal robot-assisted radical nephrectomy with IVC level I (20%) II (30%) III (46.7%) and IV (3.3%) tumor thrombectomy.
Methods: Thirty consecutive patients with renal tumor and IVC thrombus were treated between July 2011 and October 2018. Baseline, perioperative and follow-up data were collected into a prospectively maintained IRB approved databases. Surgical technique has been previously described. We report perioperative and oncologic outcomes of 30 consecutive patients treated in a tertiary referral center.
Results: All procedures were successfully completed. No conversion to open or laparoscopic surgery occurred. Median operative time was 3600 minutes. Eleven patients (47.8%) did not experience any complication. Eleven patients (43,4%) required blood transfusion (Clavien grade 2); one patient (3,3%) had a Clavien grade 3a complication (gastroscopy); two patients (3,3%) had Clavien grade 3b complication (reintervention due to bleeding from adrenal gland; cardiac cardioversion); Two patients (6,6%) required ICU admission (Clavien 4a), for PRESS syndrome and atrial fibrillation, respectively. Out of 12 patients who underwent cytoreductive nephrectomy and IVC thrombectomy, at a median follow-up of 20 months (IQR 12-35), 2-yr cancer specific and overall survival rates were 50%. Eighteen patients received surgery with curative intent and 8 of these experienced disease recurrence. three patients died of disease progression; 2-yr disease-free and cancer specific survival rates were 55.6% and 60%, respectively.
Conclusions: Robotic IVC tumor thrombectomy has demonstrated to be a feasible and safe surgical procedure in tertiary referral centers. Favorable perioperative outcomes represent a rational base to expand indications also in the cytoreductive setting.