Robot-assisted Cavectomy Versus Thrombectomy for Level II Inferior Vena Cava Thrombus: Decision-making Scheme and Multi-institutional Analysis
Robot-assisted Cavectomy Versus Thrombectomy for Level II Inferior Vena Cava Thrombus: Decision-making Scheme and Multi-institutional Analysis
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DOI：
10.1016/j.eururo.2020.03.020
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发表时间：
2020-10-01
期刊：
影响因子：
23.4
通讯作者：
Zhang, Xu
中科院分区：
文献类型：
--
作者：
Shi, Taoping;Huang, Qingbo;Zhang, Xu
背景：机器人辅助下腔静脉（IVC）血栓切除术（RAT-IVCT）的报道越来越多。然而，机器人辅助下腔静脉血栓切除术（RAC）的技术和适应症尚未得到很好的描述。目的：制定决策程序并分析RAC-IVCT与RAT-IVCT的多机构结局。设计、设置和参与者：来自中国8个泌尿外科中心的90例IVCT II级肾细胞癌（RCC）患者，2013年6月至2019年1月，行RAC-IVCT（30例）或RAT-IVCT（60例）。手术方式：根据IVCT影像学特点制定手术策略。采用标准化腔静脉切开术、血栓切除术和IVC重建进行了RAT-IVCT。RAC-IVCT主要用于侧支血管建立良好的广泛IVC壁侵犯患者。对于右侧RCC，缝合从肾下静脉到肝下静脉的IVC。左侧肾细胞癌，从肾上静脉到肝下静脉的下腔静脉被删除，尾侧下腔静脉重建进行，以确保右肾静脉返回通过下腔静脉conditions.Measurements：临床病理，手术和生存结局进行了收集和analyzed.Results和限制：所有程序都成功地进行了开放转换。RAC-IVCT的中位手术时间（268 vs 190 min）和估计失血量（1500 vs 400 ml）显著大于RAT-IVCT（均p < 0.001）。IVC侵犯是中期随访时无进展生存和总生存的危险因素。大容量和长期的后续研究是needed.Conclusions：RAC-IVCT或RAT-IVCT是一种替代微创方法，为选定的RCC患者与II级IVCT。RAC-IVCT或RAT-IVCT的选择主要基于术前IVCT成像特征，包括IVC壁侵犯的存在，受影响的肾脏和侧支循环的建立。患者摘要：在这项研究中，我们发现机器人手术治疗II级下腔静脉血栓是可行和安全的。术前影像学检查在制定合适的手术方案中起着重要作用。(C)2020年由Elsevier B. V.代表欧洲泌尿外科协会发布。
Background: Robot-assisted thrombectomy (RAT) for inferior vena cava (IVC) thrombus (RAT-IVCT) is being increasingly reported. However, the techniques and indications for robot-assisted cavectomy (RAC) for IVC thrombus are not well described.Objective: To develop a decision-making program and analyze multi-institutional outcomes of RAC-IVCT versus RAT-IVCT.Design, setting, and participants: Ninety patients with renal cell carcinoma (RCC) with level II IVCT were included from eight Chinese urological centers, and underwent RAC-IVCT (30 patients) or RAT-IVCT (60 patients) from June 2013 to January 2019.Surgical procedure: The surgical strategy was based on IVCT imaging characteristics. RAT-IVCT was performed with standardized cavotomy, thrombectomy, and IVC reconstruction. RAC-IVCT was mainly performed in patients with extensive IVC wall invasion when the collateral blood vessels were well-established. For right-sided RCC, the IVC from the infrarenal vein to the infrahepatic veins was stapled. For left-sided RCC, the IVC from the suprarenal vein to the infrahepatic veins was removed and caudal IVC reconstruction was performed to ensure the right renal vein returned through the IVC collaterals.Measurements: Clinicopathological, operative, and survival outcomes were collected and analyzed.Results and limitations: All procedures were successfully performed without open conversion. The median operation time (268 vs 190 min) and estimated blood loss (1500 vs 400 ml) were significantly greater for RAC-IVCT versus RAT-IVCT (both p < 0.001). IVC invasion was a risk factor for progression-free and overall survival at midterm follow-up. Large-volume and long-term follow-up studies are needed.Conclusions: RAC-IVCT or RAT-IVCT represents an alternative minimally invasive approach for selected RCC patients with level II IVCT. Selection of RAC-IVCT or RAT-IVCT is mainly based on preoperative IVCT imaging characteristics, including the presence of IVC wall invasion, the affected kidney, and establishment of the collateral circulation.Patient summary: In this study we found that robotic surgeries for level II inferior vena cava thrombus were feasible and safe. Preoperative imaging played an important role in establishing an appropriate surgical plan. (C) 2020 Published by Elsevier B.V. on behalf of European Association of Urology.