Robotic Nephrectomy With Inferior Vena Cava Thrombectomy Feasible, Safe in Select Patients

By Leah Lawrence - Last Updated: August 26, 2022

Robotic inferior vena cava thrombectomy (R-CT) was not inferior to standard open inferior vena cava thrombectomy (O-CT), showing it is a safe and effective alternative approach for kidney cancer, according to a study published in the Journal of Urology.

Researchers at The Mays Cancer Center at The University of Texas Health Science Center at San Antonio conducted a systematic review and meta-analysis of data from 28 studies that enrolled 1,375 patients from different medical centers.

In the single-arm studies of R-CT, 329 patients who underwent R-CT were included. Most of these patients had right-sided tumors (74.9%; 245/327). Most patients had a level I (14.7%), level II (60.9%), or level III (20.4%) thrombus.

Most of the surgeries were performed by “extensively experienced robotic surgeons and involved a multidisciplinary approach with intraoperative collaboration of hepatobiliary surgeons and cardiovascular surgeons,” researchers wrote.

In this group of patients, 38.2% received perioperative blood transfusion. Intraoperative complications occurred in 1.8% of patients. The overall perioperative complication rate was 30.3% with a major complication rate of 8.5%.

The researchers also looked at four studies comparing R-CT with O-CT. These studies comprised 110 patients undergoing R-CT and 936 undergoing O-CT. Results showed that 18.4% of patients who underwent R-CT required transfusions compared with 64.3% of those who underwent O-CT.

Additionally, the overall complication rate was significantly lower for R-CT compared with O-CT (14.5% vs. 36.7%; P=.005). The major complication rate was not significantly different between the two groups.

“That tells us there is more room for us to grow and refine this robotic procedure and to offer it to patients who are optimal candidates for it,” said Dharam Kaushik, MD, urologic oncology fellowship program director, at UT Health San Antonio. “Optimal candidacy for a robotic surgery should be based on a surgeon’s robotic expertise, the extent and burden of the tumor, and the patient’s comorbid conditions. The open surgical approach remains the gold standard for achieving excellent surgical control.”

Reference

A Decade of Robotic-Assisted Radical Nephrectomy with Inferior Vena Cava Thrombectomy: A Systematic Review and Meta-Analysis of Perioperative Outcomes

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