Robotic-Management for Renal Cell Carcinoma with Venous System Involvement at a Community Hospital: Case Series

Abstract

Background: Kidney cancer accounts for 2.6% of all visceral malignancies in the USA. Around 5–10% of patients with renal cell carcinoma (RCC) have renal venous involvement. Open nephrectomy with tumour thrombectomy has classically been the gold standard for treatment of these masses. As opposed to open surgery, minimally invasive surgery is associated with less intraoperative blood loss, shorter hospital stays, and lower complication rates. In this study, the authors present a series of robotic radical nephrectomies in patients with renal venous invasion. Materials and methods: Between November 2016 and March 2021, 10 patients with RCC with renal venous invasion underwent radical nephrectomies. In eight patients, renal venous invasion was evident based on CT. In four cases, tumour thrombus invaded the inferior vena cava. In three of these cases, the tumour thrombus was able to be milked back into the renal vein, allowing for ligation and transection in the standard fashion. In the remaining case, cavotomy and tumour thrombus extraction was required. Results: All cases were performed completely robotically, without requiring open conversion. Median operative time was 136 minutes. Median estimated blood loss was 450 mL. Median length of hospitalisation was 2.5 days. Eight patients had no complications following the procedure. Conclusion: In the setting of a community hospital, robotic management of patients with T3a and T3b RCC with venous invasion is a safe and effective alternative to open surgery.