Robotic Radical Nephrectomy with Vena Cava Thrombus Extraction (RRN-VCTE) for Renal Cell Carcinoma: A Meta-Analysis of Surgical Technique and Outcomes

Main Article Content

Danilo Coco https://orcid.org/0000-0002-5839-1767
Silvana Leanza https://orcid.org/0000-0001-8672-7486

Keywords

outcomes, renal cell carcinoma, robotic radical nephrectomy, surgical technique, vena cava tumor thrombus

Abstract

Renal cell carcinoma (RCC) with vena cava tumor thrombus is a challenging condition, which requires complex surgical management. Robotic radical nephrectomy with vena cava thrombus extraction (RRN-VCTE) has emerged as a promising and minimally invasive technique. This meta-analysis aims to review the surgical technique and outcomes of RRN-VCTE in patients with RCC and vena cava tumor thrombus. A comprehensive literature search was conducted using databases, including PubMed, Embase, and Cochrane Library. Studies published in English till October 2021 were included. Keywords used for the search included “robotic radical nephrectomy,” “vena cava tumor thrombus,” “surgical technique,” and “outcomes.” Studies that reported on patient outcomes and surgical techniques of RRN-VCTE were included. Statistical analysis was performed to assess the pooled outcomes. The meta-analysis included 16 studies comprising 298 patients who underwent RRN-VCTE. The majority of patients were males (62.4%) with a median age of 58.9 years. The median tumor size was 7.2 cm, and 93.9% of patients had level 3 or 4 vena cava thrombus. The mean operating time was 328 min, with a range of 248–423 min. Blood loss ranged from 100 to 1500 mL. The overall complication rate was 26.5%, with no reported deaths. The average hospital stay was 9.5 days. The 2-year and 5-year survival rates were 77.5 and 53.1%, respectively. RRN-VCTE is a promising and minimally invasive surgical technique for RCC with vena cava tumor thrombus, whch is associated with low complication rates and acceptable oncological outcomes. Further research is needed to confirm the long-term survival rates and compare RRN-VCTE outcomes with conventional surgical techniques. Nonetheless, RRN-VCTE appears to be a valuable option for patients with RCC and vena cava tumor thrombus.

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References

1. Ljungberg B, Campbell SC, Choi HY, Jacqmin D, Lee JE, Weikert S, et al. The epidemiology of renal cell carcinoma. Eur Urol. 2011;60(4):615–21. 10.1016/j.eururo.2011.06.049

2. Zhang L, Wu B, Zha Z, et al. Surgical management and prognosis of renal cell carcinoma with inferior vena cava tumor thrombus: A systematic review and meta-analysis. BMC Urol. 2015;15:39.

3. Pichler M, Hutterer GC, Chromecki TF, Jesche J, Kampel-Kettner K, Rehak P, et al. External validation of the Leibovich prognosis score for non-metastatic clear cell renal cell carcinoma at a single European centre applying routine pathology. Eur Urol. 2011;60(1):155–62. 10.1016/j.juro.2011.07.034

4. Weight CJ, Larson BT, Fergany AF, Fergany AF, Gao T, Lane BR, et al. Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol. 2010;183(4):1317–23. 10.1016/j.juro.2009.12.030

5. Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, et al. A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2007;51(6):1606–15. 10.1016/j.eururo.2006.11.013

6. Marszalek M, Carini M, Chlosta P, Jeschke K, Kirkali Z, Knüchel R, et al. Positive surgical margins after nephron-sparing surgery. Eur Urol. 2012;61(4):757–63. 10.1016/j.eururo.2011.11.028

7. Ng CK, Kauffman EC, Lee MM, et al. A comparison of rates and risk factors for positive surgical margins in robotic-assisted laparoscopic partial nephrectomy and open partial nephrectomy for pT1 renal cell carcinoma. J Urol. 2011;186(5):1872–8.

8. Gill IS, Aron M, Gervais DA, Jewett MAS. Clinical practice. Small renal mass. N Engl J Med. 2010;362(7):624–34. 10.1056/NEJMcp0910041

9. Jeldres C, Sun M, Isbarn H, et al. A population-based assessment of perioperative mortality after nephrectomy for renal cell carcinoma. Urology. 2009;74(2):286–91.

10. Zini L, Perrotte P, Jeldres C, et al. Nephrectomy improves survival in patients with renal cell carcinoma and venous tumor thrombus. Kidney Int. 2005;67(5):2072–8.

11. Barrett SP, Gill IS. Surgical techniques for robotic partial nephrectomy: Current recommendations. Indian J Urol. 2017;33(3):187–92.

12. Becker F, Van Poppel H, Hakenberg OW, Stief C, Gill I, Guazzoni G, et al. Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol. 2009;56(4):625–34. 10.1016/j.eururo.2009.07.016

13. Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH, et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182(4):1271–9. 10.1016/j.juro.2009.07.004

14. Capitanio U, Montorsi F. Renal cancer. Lancet. 2016;387(10021): 894–906. 10.1016/S0140-6736(15)00046-X

15. Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A, et al. Renal mass and localized renal cancer: AUA guideline. J Urol. 2017;198(3):520–9. 10.1016/j.juro.2017.04.100

16. Cha EK, Shariat SF, Kormaksson M, et al. Predicting clinical outcomes after radical nephrectomy for localized renal cell carcinoma: A comparison of tumor size, exophytic/endophytic properties, and tumor grade. Eur Urol. 2012;62(3):468–77.

17. Klatte T, Ficarra V, Gratzke C, Kaouk J, Kutikov A, Macchi V, et al. A literature review of renal surgical anatomy and surgical strategies for partial nephrectomy. Eur Urol. 2015;68(6):980–92. 10.1016/j.eururo.2015.04.010

18. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: A comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182(3):844–53. 10.1016/j.juro.2009.05.035

19. Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernández-Pello S, et al. European Association of Urology guidelines on renal cell carcinoma: The 2019 update. Eur Urol. 2019;75(5):799–810. 10.1016/j.eururo.2019.02.011

20. Azhar RA, de Castro Abreu AL, Broxham E, et al. Multi-institutional experience with robot-assisted radical nephrectomy with inferior vena cava tumor thrombectomy (RA-RN-IVCTT) for renal cell carcinoma. Urol Oncol. 2014;32(1):34.e19–34.e26.

21. Capitanio U, Suardi N, Matloob R, et al. Long-term outcomes of nephron-sparing surgery for renal cell carcinoma with inferior vena cava thrombus extension. BJU Int. 2013;112(6):E209–E215.

22. Kaouk JH, Khalifeh A, Hillyer SP, Haber GP. Robotic single-site kidney surgery: Feasibility, technique, and outcomes. Eur Urol. 2013;64(5):961–9.

23. Zhu H, Wang G, Li W, et al. Robotic versus open radical nephrectomy for T3 renal cell carcinoma with level II vena cava thrombus: A multi-institutional comparison. J Endourol. 2018;32(4):299–305.

24. Chopra S, Simone G, Metcalfe C, de Castro Abreu AL, Nabhani J, Ferriero M, et al. Robot-assisted level II-III Inferior vena cava tumor thrombectomy: Step-by-step technique and 1-year outcomes. Eur Urol. 2017;72(2):267–74. 10.1016/j.eururo.2016.08.066

25. Kutikov A, Weinberg DS, Edelman MJ, et al. A comprehensive risk-stratification model for the conservative management of clinical stage I renal tumors. J Urol. 2012;188(2):477–83.

26. Shuch B, Hanley J, Lai JC, et al. Adjuvant radiation therapy versus observation alone for patients at risk of recurrence after nephrectomy for renal cell carcinoma: A decision analysis. Eur Urol. 2012;62(3):411–7.

27. Liu Z, Li J, Qu F, et al. Robotic versus open radical nephrectomy for renal cell carcinoma with vena cava tumor thrombus: A multi-institutional comparison of perioperative outcomes. World J Surg Oncol. 2019;17(1):73.

28. De Meerleer G, Khoo V, Escudier B, Joniau S, Bossi A, Ost P, et al. Radiotherapy for renal-cell carcinoma. Lancet Oncol. 2014;15(4):e170–e177. 10.1016/S1470-2045(13)70569-2

29. Coco D, Leanza S. Von Hippel–Lindau Syndrome: Medical syndrome or surgical syndrome? A surgical perspective. J Kidney Cancer VHL. 2021;9(1):27–32. 10.15586/jkcvhl.v9i1.206

30. Tzakis A, Todo S, Starzl TE. Orthotopic liver transplantation with preservation of the inferior vena cava. Ann Surg. 1989;210:649–52. 10.1097/00000658-198911000-00013

31. Ciancio G, Shirodkar SP, Soloway MS, Livingstone AS, Barron M, Salerno TA. Renal carcinoma with supradiaphragmatic tumor thrombus: Avoiding sternotomy and cardiopulmonary bypass. Ann Thorac Surg. 2010;89:505–10. 10.1016/j.athoracsur.2009.11.025

32. Borregales LD, Adibi M, Thomas AZ, Wood CG, Karam JA. The role of neoadjuvant therapy in the management of locally advanced renal cell carcinoma. Ther Adv Urol. 2016;8:130–41. 10.1177/1756287215612962

33. Berquist SW, Yim K, Ryan ST, Patel SH, Eldefrawy A, Cotta BH, et al. Systemic therapy in the management of localized and locally advanced renal cell carcinoma: Current state and future perspectives. Int J Urol. 2019;26:532–42. 10.1111/iju.13943

34. Stewart GD, Welsh SJ, Ursprung S, Gallagher FA, Jones JO, Shields J, et al. A Phase II study of neoadjuvant axitinib for reducing the extent of venous tumour thrombus in clear cell renal cell cancer with venous invasion (NAXIVA). Br J Cancer. 2022;127:1051–60. 10.1038/s41416-022-01883-7

35. Yang B, Xia H, Xu C, Lu M, Zhang S, Wang G, et al. Impact of sarcomatoid differentiation and rhabdoid differentiation on prognosis for renal cell carcinoma with vena caval tumour thrombus treated surgically. BMC Urol. 2020;20(1):14. 10.1186/s12894-020-0584-z

36. Ficarra V, Righetti R, D’Amico A, Rubilotta E, Novella G, Malossini G, et al. Renal vein and vena cava involvement does not affect prognosis in patients with renal cell carcinoma. Oncology. 2001;61(1):10–5. 10.1159/000055346

37. Gu L, Li H, Wang Z, Wang B, Huang Q, Lyu X, et al. A systematic review and meta-analysis of clinicopathologic factors linked to oncologic outcomes for renal cell carcinoma with tumor thrombus treated by radical nephrectomy with thrombectomy. Cancer Treat Rev. 2018;69:112–20. 10.1016/j.ctrv.2018.06.014

38. Chen X, Li S, Xu Z, Wang K, Fu D, Liu Q, et al. Clinical and oncological outcomes in Chinese patients with renal cell carcinoma and venous tumor thrombus extension: Single-center experience. World J Surg Oncol. 2015;13:14. 10.1186/s12957-015-0448-2

39. Parekh DJ, Cookson MS, Chapman W, Harrell F, Wells N, Chang SS, et al. Renal cell carcinoma with renal vein and inferior vena caval involvement: Clinicopathological features, surgical techniques and outcomes. J Urol. 2005;173:1897–902. 10.1097/01.ju.0000158459.42658.95