Open radical nephrectomy with inferior vena cava thrombectomy (O-CT) is standard management for renal cell carcinoma with inferior vena caval thrombus. First reported a decade ago, robotic radical nephrectomy with caval tumor thrombectomy (R-CT) is a minimally invasive option for this disease. We aimed to perform a systematic review to assess the safety and feasibility of R-CT in terms of perioperative outcomes and compare the outcomes between R-CT and O-CT.
The PubMed®, Scopus®, Cochrane Central Register of Controlled Trials and Web of ScienceTM databases were searched using the free-text and MeSH terms "renal cell carcinoma," "inferior vena cava," "thrombosis" or "thrombus," "robot" and "thrombectomy." Studies reporting perioperative outcomes of R-CT and studies comparing R-CT with O-CT were included. The review was done in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
The searches retrieved 28 articles describing R-CT, including 7 comparative studies. This systematic review included 1,375 patients, out of which 329 patients were in single-arm studies and 1,046 patients were in comparative studies. Of 329 patients who underwent R-CT, 14.7% were level I, 60.9% level II, 20.4% level III and 2.5% level IV thrombus. Operative time ranged from 150 to 530 minutes; blood transfusion was administered in 38.2% (126). The overall complication rate was 30.3% (99). R-CT, in comparison to O-CT, was associated with a lower blood transfusion rate (18.4% vs 64.3%, p=0.002) and a lower complication rate (14.5% vs 36.7%, p=0.005). Major complication and 30-day mortality rates were similar in both groups.
R-CT has acceptable perioperative outcomes in carefully selected patients. Compared with O-CT, R-CT is associated with a lower blood transfusion rate and fewer overall complications. In experienced hands with carefully selected patients, R-CT is feasible and safe, with acceptable outcomes; however, selection bias limits definitive inference of these results, and optimal patient selection criteria remain to be described.
The Journal of urology. 2022 Jun 28 [Epub ahead of print]
Harshit Garg, Sarah P Psutka, Abraham Ari Hakimi, Hyung L Kim, Ahmed M Mansour, Deepak Pruthi, Michael A Liss, Hanzhang Wang, Christine S Gaspard, Chethan Ramamurthy, Robert S Svatek, Dharam Kaushik
Department of Urology, University of Texas Health, San Antonio, Texas., Department of Urology, University of Washington, Seattle, Washington., Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York., Department of Surgery/Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California., Dolph Briscoe Jr Library, University of Texas Health, San Antonio, Texas., Department of Medical Oncology, Mays Cancer Centre, San Antonio, Texas.