For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
1
views
14
references
 Top references
cited by
2
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      458
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Robot-assisted laparoscopic radical nephrectomy and inferior vena cava thrombectomy: A multicentre Indian experience

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          ABSTRACT

          Objective

          To assess feasibility of robot-assisted laparoscopic radical nephrectomy (RALRN) and inferior vena cava thrombectomy (IVCT) in treating renal tumours with level I–III IVC thrombi and to assess their outcomes.

          Patients and methods

          We conducted a retrospective analysis of RALRN-IVCTs, involving four centres across India, from September 2015 to June 2019. We analysed patients who underwent RALRN-IVCT for level I–III thrombi according to the Mayo classification. The total operative duration with console time, length of hospital stay, preoperative and postoperative creatinine, IVC clamp time and intraoperative blood loss were recorded.

          Results

          Of the 13 patients that underwent RALRN-IVCT, five had a level I thrombus, seven had level II, and one had a level III thrombus. In all, 11 of the patients had right-sided tumours and the remaining two had left-sided tumours. The mean (SD) age of the patients was 56.5 (12.3) years, the mean (SD) operative time was 329.5 (97.22) min, the mean (SD) console time was 222.5 (70) min, the mean (SD) blood loss was 395 (170) mL, and the mean (SD) IVC clamp time was 19.14 (9.5) min. The mean (SD) length of hospital stay was 7.8 (3.27) days. Of the 13 patients, 12 had clear cell renal cell carcinoma (RCC) and one had papillary RCC. The mean (range) follow-up was 19 (4–50) months. One patient had upfront metastasis and two patients developed metastasis, while 10 patients remained disease-free during the follow-up.

          Conclusion

          With appropriate patient selection, surgical planning and robotic experience, completely intracorporeal robotic level I–III IVCT is feasible and can be performed efficiently. Larger experiences, with longer follow-ups and comparisons with open surgery are needed to confirm these initial outcomes.

          Abbreviations

          ECOG: Eastern Cooperative Oncology Group; IVC: inferior vena cava; IVCT: inferior vena cava thrombectomy; (RAL)RN: (robot-assisted laparoscopic) radical nephrectomy

          Related collections

          Most cited references14

          • Record: found
          • Abstract: found
          • Article: not found

          Surgical treatment of renal cancer with vena cava extension.

          Horst Zincke, R. Neves (1987)
          Fifty-four patients with renal cancer and vena cava tumour thrombus underwent radical nephrectomy and removal of the thrombus; the operative mortality rate was 9.3% (5 patients). The extent of the vena cava thrombus did not affect survival. Of 36 patients with no known pre-operative metastases and complete (29 patients) and incomplete (7 patients) removal of the vena cava tumour thrombus, the 5-year survival rate was 68 and 17%, respectively (P = 0.01). Thirteen patients (45%) who underwent complete removal of the vena cava tumour thrombus are alive and free of disease, with a mean follow-up of 51.2 months (range 4-144); three died without disease 110, 31 and 23 months after operation. The 2-year and 5-year survival rates of 18 patients with known pre-operative metastases was 37.5 and 12.5% respectively; 14 died between 1 and 27 months post-operatively (mean 11.6) of metastatic disease. Two of these 18 patients experienced long-term remission: one died of unrelated causes 151 months after operation; the other was lost to follow-up 219 months after operation, with no evidence of disease. Of 14 patients with positive regional nodes, the mean survival in those with metastases compared with those without metastases was 7.5 versus 15 months, respectively; only one patient survived at 14 months. Operative intervention in patients without metastatic disease (systemic or regional) and complete removal of the vena cava thrombus achieved a 5-year survival rate of 68%. Variables which significantly decreased survival and may be considered contraindications for operation were systemic metastasis, regional lymph node involvement and incomplete removal of the vena cava thrombus.
          Article 0 comments Cited 102 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: single-center experience.

            Gaetano Ciancio, Murugesan Manoharan, Devendar Katkoori … (2010)
            Renal cell carcinoma (RCC) with a tumor thrombus extension into the inferior vena cava (IVC) demands aggressive surgical management. To evaluate the long-term survival in patients undergoing radical nephrectomy and IVC thrombectomy. We performed a retrospective analysis of 87 patients undergoing surgery between 1997 and 2008. The patients were grouped according to the extent of tumor thrombus, with level I involving the IVC at the level of the renal vein, level II being infrahepatic IVC, level III being intrahepatic IVC, and level IV being suprahepatic IVC or right atrium. Relevant clinical and pathologic data were analyzed. Disease-free survival (DFS) and disease-specific survival (DSS) were studied. The median follow-up was 22 mo, and 19, 14, 40, and 14 patients had level I, II, III, and IV IVC thrombus, respectively. Among patients with M0 disease, 22 developed metastases. The 5-yr DFS was 64% for all levels and 74%, 69.5%, 59.5%, and 58% for levels I, II, III, and IV, respectively. Of the level I group, 16% of patients died of disease compared to 57% of the level IV group. The 5-yr DSS for all levels was 46% and 71%, 48%, 40%, and 35% for levels I, II, III, and IV, respectively. Patients with level IV thrombus had a significantly lower 5-yr DSS compared to level I (p=0.03). However, when analyzed in two groups-supradiaphragmatic and infradiaphragmatic-there was no significant difference in DSS (P=0.14). On univariate analysis, metastasis at presentation, non-clear-cell histology, lymph node metastases, and higher nuclear grade were statistically significant prognostic factors influencing DSS. Only higher nuclear grade (p=0.03), metastasis at presentation (p<0.01), and non-clear-cell histology (p=0.03) were independent prognostic factors on multivariate analysis. Radical nephrectomy and IVC thrombectomy offer reasonable long-term survival. The level of tumor thrombus is not an independent prognostic factor. Distant metastasis at presentation, higher nuclear grade, and non-clear-clear cell histology are significant prognostic factors influencing DSS. Copyright © 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.
            Article 0 comments Cited 45 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Initial series of robotic radical nephrectomy with vena caval tumor thrombectomy.

              Ronney Abaza (2011)
              Laparoscopy has become a standard modality for most renal tumors but not as yet for renal cell carcinoma (RCC) involving the inferior vena cava (IVC). Robotic technology may facilitate such complex procedures. We report the first series of robotic nephrectomy with IVC tumor thrombectomy including the first cases requiring cross-clamping of the IVC in a minimally invasive fashion. Five patients underwent robotic nephrectomy with IVC tumor thrombectomy including one patient having two renal veins, each with an IVC thrombus, for a total of six IVC thrombi. The IVC was opened in all patients, and tumor thrombi were delivered intact, followed by sutured closure. The mean patient age was 64 yr (53-70 yr) with a mean body mass index of 36.6 kg/m(2) (22-43 kg/m(2)). Thrombi protruded 1 cm, 2 cm, 4 cm, and 5 cm into the IVC in five patients and 3 cm and 2 cm in the patient with two thrombi. The mean estimated blood loss was 170 ml (50-400 ml). Mean operative time was 327 min (240-411 min). Mean length of stay was 1.2 d. There were no complications, transfusions, or readmissions. This early series represents a limited experience by a single surgeon with a new procedure and may not be reproducible in larger numbers or by all surgeons. Further experience is necessary to validate this application. Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.
              Article 0 comments Cited 40 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (nlm-ta): Arab J Urol
                Title: Arab Journal of Urology
                Publisher: Taylor & Francis
                ISSN (Print): 2090-598X
                ISSN (Electronic): 2090-5998
                Publication date (Electronic, pub): 25 March 2020
                Publication date (Electronic, collection): 2020
                Volume: 18
                Issue: 2
                Pages: 124-128
                Affiliations
                [a ]Department of Urology, Aster Medcity; , Kochi, India
                [b ]Department of Urology, Muljibhai Patel Urology Hospital; , Nadiad, India
                [c ]Department of Urology, Max Hospital Saket; , New Delhi, India
                [d ]Department of Urology, Amrita Institute of Medical Sciences; , Kochi, India
                Author notes
                CONTACT Thekke Adiyat Kishore kishoreta@ 123456yahoo.com Department of Urology, Aster Medcity; , Kochi, India
                Author information
                https://orcid.org/0000-0003-2678-0634
                https://orcid.org/0000-0002-3106-706X
                https://orcid.org/0000-0003-1761-1783
                https://orcid.org/0000-0002-7090-7885
                Article
                Publisher ID: 1738104
                DOI: 10.1080/2090598X.2020.1738104
                PMC ID: 7473165
                SO-VID: 0df8f55f-c8a0-43ab-af21-b4feb8ee2d7f
                Copyright © © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 3, Tables: 2, References: 18, Pages: 5
                Categories
                Subject: Research Article
                Subject: Laparoscopy/Robotics

                Keywords: robot-assisted laparoscopic radical nephrectomy,inferior vena cava thrombectomy,robotic vena cava surgery,renal cell carcinoma
                Data availability:
                Keywords: robot-assisted laparoscopic radical nephrectomy, inferior vena cava thrombectomy, robotic vena cava surgery, renal cell carcinoma

                Comments

                Comment on this article

                scite_

                Similar content458

                See all similar

                Cited by2

                See all cited by

                Most referenced authors299

                See all reference authors