Clinical efficacy of robot-assisted laparoscopic versus open radical nephrectomy plus inferior vena cava thrombectomy

Abstract

Objective To summarize our surgical techniques and clinical experience of robot-assisted laparoscopic radical nephrectomy (RARN) and open radical nephrectomy (ORN) plus inferior vena cava thrombectomy (IVCT), and compare the clinical outcomes and safety of the 2 procedures. Methods A retrospective cohort study was conducted on 26 patients diagnosed with renal tumor complicated with inferior vena cava tumor thrombus who underwent radical nephrectomy plus inferior vena cava thrombectomy in our department from 2012 to 2022. Among them, 12 patients were conducted with ORN plus IVCT (O-IVCT), including 3 cases having cardiopulmonary bypass, and the other 14 patients received RARN plus IVCT (RA-IVCT), of them 2 cases experienced conversion to open surgery. Surgical characteristics, such as operative time, intraoperative duration for blocking the vena cava, intraoperative bleeding volume, postoperative length of hospital stay and rates of intraoperative blood transfusion and postoperative conversion to ICU were compared between the 2 groups. Results The average operative time was 394±141 min in all cases, and the time of blocking the inferior vena cava was 23.90±6.95 min excluding 3 cases undergoing cardiopulmonary bypass. There were no significantly differences in the average age, body mass index (BMI), tumor size, pathological T stage, or tumor thrombus level by Mayo classification between the RA-IVCT and O-IVCT group. The patients from the RA-IVCT group had a median intraoperative bleeding volume of 600 (50~1 600) mL, significantly less than that in the O-IVCT group [1 100 (600~3 800) mL, P=0.049]. No statistical differences were observed between the RA-IVCT group and O-IVCT group in following indicators: mean operative time (323±102 vs 401±95 min, P=0.089), mean duration of blocking the inferior vena cava (26.10±7.03 vs 20.20±6.16 min, P=0.057), rate of blood transfusion (8/12 vs 8/9, P=0.338), rate of ICU admission (3/12 vs 6/9, P=0.087), or median length of hospital stay after surgery [7(4~14) vs 8(7~20) d, P=0.091]. Conclusion RA-IVCT is a safe and effective operation, with the advantage of less intraoperative bleeding volume when compared with O-IVCT.

Keywords

• inferior vena cava thrombectomy
• radical nephrectomy
• robotic surgical procedures