Clinical efficacy of robot-assisted laparoscopic versus open radical nephrectomy plus inferior vena cava thrombectomy

Objective To summarize our surgical techniques and clinical experience of robot-assisted laparoscopic radical nephrectomy (RARN) and open radical nephrectomy (ORN) plus inferior vena cava thrombectomy (IVCT), and compare the clinical outcomes and safety of the 2 procedures. Methods A retrospective c...

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Main Authors: YAN Xuzhi, WANG Shuo, LIU Qiuli
Format: Article
Language:zho
Published: Editorial Office of Journal of Army Medical University 2023-10-01
Series:陆军军医大学学报
Subjects:
Online Access:http://aammt.tmmu.edu.cn/html/202208120.htm
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author YAN Xuzhi
WANG Shuo
LIU Qiuli
author_facet YAN Xuzhi
WANG Shuo
LIU Qiuli
author_sort YAN Xuzhi
collection DOAJ
description Objective To summarize our surgical techniques and clinical experience of robot-assisted laparoscopic radical nephrectomy (RARN) and open radical nephrectomy (ORN) plus inferior vena cava thrombectomy (IVCT), and compare the clinical outcomes and safety of the 2 procedures. Methods A retrospective cohort study was conducted on 26 patients diagnosed with renal tumor complicated with inferior vena cava tumor thrombus who underwent radical nephrectomy plus inferior vena cava thrombectomy in our department from 2012 to 2022. Among them, 12 patients were conducted with ORN plus IVCT (O-IVCT), including 3 cases having cardiopulmonary bypass, and the other 14 patients received RARN plus IVCT (RA-IVCT), of them 2 cases experienced conversion to open surgery. Surgical characteristics, such as operative time, intraoperative duration for blocking the vena cava, intraoperative bleeding volume, postoperative length of hospital stay and rates of intraoperative blood transfusion and postoperative conversion to ICU were compared between the 2 groups. Results The average operative time was 394±141 min in all cases, and the time of blocking the inferior vena cava was 23.90±6.95 min excluding 3 cases undergoing cardiopulmonary bypass. There were no significantly differences in the average age, body mass index (BMI), tumor size, pathological T stage, or tumor thrombus level by Mayo classification between the RA-IVCT and O-IVCT group. The patients from the RA-IVCT group had a median intraoperative bleeding volume of 600 (50~1 600) mL, significantly less than that in the O-IVCT group [1 100 (600~3 800) mL, P=0.049]. No statistical differences were observed between the RA-IVCT group and O-IVCT group in following indicators: mean operative time (323±102 vs 401±95 min, P=0.089), mean duration of blocking the inferior vena cava (26.10±7.03 vs 20.20±6.16 min, P=0.057), rate of blood transfusion (8/12 vs 8/9, P=0.338), rate of ICU admission (3/12 vs 6/9, P=0.087), or median length of hospital stay after surgery [7(4~14) vs 8(7~20) d, P=0.091]. Conclusion RA-IVCT is a safe and effective operation, with the advantage of less intraoperative bleeding volume when compared with O-IVCT.
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spelling doaj.art-3c45582141724c2bba6b23c4814d188e2023-10-26T02:59:27ZzhoEditorial Office of Journal of Army Medical University陆军军医大学学报2097-09272023-10-0145202099210510.16016/j.2097-0927.202208120Clinical efficacy of robot-assisted laparoscopic versus open radical nephrectomy plus inferior vena cava thrombectomyYAN Xuzhi0WANG Shuo1LIU Qiuli2Department of Urology, Army Medical Center of PLA, Chongqing, 400042, ChinaDepartment of Urology, Army Medical Center of PLA, Chongqing, 400042, ChinaDepartment of Urology, Army Medical Center of PLA, Chongqing, 400042, ChinaObjective To summarize our surgical techniques and clinical experience of robot-assisted laparoscopic radical nephrectomy (RARN) and open radical nephrectomy (ORN) plus inferior vena cava thrombectomy (IVCT), and compare the clinical outcomes and safety of the 2 procedures. Methods A retrospective cohort study was conducted on 26 patients diagnosed with renal tumor complicated with inferior vena cava tumor thrombus who underwent radical nephrectomy plus inferior vena cava thrombectomy in our department from 2012 to 2022. Among them, 12 patients were conducted with ORN plus IVCT (O-IVCT), including 3 cases having cardiopulmonary bypass, and the other 14 patients received RARN plus IVCT (RA-IVCT), of them 2 cases experienced conversion to open surgery. Surgical characteristics, such as operative time, intraoperative duration for blocking the vena cava, intraoperative bleeding volume, postoperative length of hospital stay and rates of intraoperative blood transfusion and postoperative conversion to ICU were compared between the 2 groups. Results The average operative time was 394±141 min in all cases, and the time of blocking the inferior vena cava was 23.90±6.95 min excluding 3 cases undergoing cardiopulmonary bypass. There were no significantly differences in the average age, body mass index (BMI), tumor size, pathological T stage, or tumor thrombus level by Mayo classification between the RA-IVCT and O-IVCT group. The patients from the RA-IVCT group had a median intraoperative bleeding volume of 600 (50~1 600) mL, significantly less than that in the O-IVCT group [1 100 (600~3 800) mL, P=0.049]. No statistical differences were observed between the RA-IVCT group and O-IVCT group in following indicators: mean operative time (323±102 vs 401±95 min, P=0.089), mean duration of blocking the inferior vena cava (26.10±7.03 vs 20.20±6.16 min, P=0.057), rate of blood transfusion (8/12 vs 8/9, P=0.338), rate of ICU admission (3/12 vs 6/9, P=0.087), or median length of hospital stay after surgery [7(4~14) vs 8(7~20) d, P=0.091]. Conclusion RA-IVCT is a safe and effective operation, with the advantage of less intraoperative bleeding volume when compared with O-IVCT. http://aammt.tmmu.edu.cn/html/202208120.htminferior vena cava thrombectomyradical nephrectomyrobotic surgical procedures
spellingShingle YAN Xuzhi
WANG Shuo
LIU Qiuli
Clinical efficacy of robot-assisted laparoscopic versus open radical nephrectomy plus inferior vena cava thrombectomy
陆军军医大学学报
inferior vena cava thrombectomy
radical nephrectomy
robotic surgical procedures
title Clinical efficacy of robot-assisted laparoscopic versus open radical nephrectomy plus inferior vena cava thrombectomy
title_full Clinical efficacy of robot-assisted laparoscopic versus open radical nephrectomy plus inferior vena cava thrombectomy
title_fullStr Clinical efficacy of robot-assisted laparoscopic versus open radical nephrectomy plus inferior vena cava thrombectomy
title_full_unstemmed Clinical efficacy of robot-assisted laparoscopic versus open radical nephrectomy plus inferior vena cava thrombectomy
title_short Clinical efficacy of robot-assisted laparoscopic versus open radical nephrectomy plus inferior vena cava thrombectomy
title_sort clinical efficacy of robot assisted laparoscopic versus open radical nephrectomy plus inferior vena cava thrombectomy
topic inferior vena cava thrombectomy
radical nephrectomy
robotic surgical procedures
url http://aammt.tmmu.edu.cn/html/202208120.htm
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AT wangshuo clinicalefficacyofrobotassistedlaparoscopicversusopenradicalnephrectomyplusinferiorvenacavathrombectomy
AT liuqiuli clinicalefficacyofrobotassistedlaparoscopicversusopenradicalnephrectomyplusinferiorvenacavathrombectomy