Renal cell carcinoma (RCC) is a common diagnosis, of which a notable portion of patients present with an extension into the venous circulation causing an inferior vena cava (IVC) tumor thrombus. Venous extension has significant implications for staging and subsequent treatment planning, with recommendations for more aggressive surgical removal, although associated surgical morbidity and mortality is relatively increased. The methods for surgical removal of RCC with IVC thrombus remain complex, particularly surrounding the use of robot-assisted surgery. Robot assistance for radical nephrectomy in this context is recently emerging. Thrombus level has important implications for surgical technique and prognosis. Other preoperative considerations may include location, laterality, size, and wall invasion. The urology literature on treatment of such tumors is largely limited to case series and institutional studies that describe the feasibility of various surgical options for these complex tumors. Further understanding of the outcomes and patient-specific risk factors would shed increased light on the optimal treatment for such cases. This narrative review provides a thorough overview on the previously reported use of robot-assisted nephrectomy in RCC with IVC thrombus to inform further studies which may optimize outcomes and guide shared decision-making.
Journal of clinical medicine. 2024 Feb 26*** epublish ***
Mihir S Shah, Kerith R Wang, Yash B Shah, Radhika Ragam, Rishabh K Simhal, Saum Ghodoussipour, Houman Djaladat, James R Mark, Costas D Lallas, Thenappan Chandrasekar
Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA., Department of Urology, Oschner Health, New Orleans, LA 70121, USA., Division of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA., Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA., Department of Urology, University of California, Davis, Sacramento, CA 92868, USA.