Top

Published in:

Open Access 01-12-2021 | Nephrectomy | Research

Pure retroperitoneal laparoscopic radical nephrectomy and thrombectomy with delayed occlusion of the proximal inferior vena cava (DOPI) technique for renal tumor with level II-III venous tumor thrombus

Authors: Zhuo Liu, Peng Hong, Guodong Zhu, Li Zhang, Xun Zhao, Shiying Tang, Feilong Yang, Xiaojun Tian, Guoliang Wang, Shudong Zhang, Hongxian Zhang, Yi Huang, Chunxia Liu, Cheng Liu, Lulin Ma

Published in: BMC Cancer | Issue 1/2021

Abstract

Purpose

To explore the safety and effectiveness of delayed occlusion of the proximal inferior vena cava (DOPI) technique in retroperitoneal laparoscopic radical nephrectomy (LRN) and thrombectomy for renal tumor with level II-III venous tumor thrombus (VTT).

Materials and methods

From August 2016 to October 2018, a total of 145 patients with renal tumor and VTT were admitted to our centre. Seventy-five patients underwent laparoscopic surgery, and 70 patients underwent open surgery. Among these patients, 17 patients underwent retroperitoneal LRN and thrombectomy with the DOPI technique. Clinical data were collected retrospectively, and a descriptive statistical analysis was conducted.

Results

All the patients successfully underwent retroperitoneal laparoscopic surgery. The mean operation time was 345.9 ± 182.9 min, the mean estimated blood loss was 466.7 ± 245.5 ml. Postoperative complications occurred in three patients, including two patients of Clavien grading system level IVa and one patient of level II. There were no complications related to carbon dioxide pneumoperitoneum, such as gas embolism, acidosis, and subcutaneous emphysema. During 21 months of median follow-up time, no local recurrence was found, and distant metastasis occurred in four patients. Cancer-specific death occurred in two patients.

Conclusions

The DOPI technique is safe and feasible in the treatment of renal tumor and level II-III VTT. With the DOPI technique, the procedures of dissociating and exposing proximal inferior vena cava are simplified.

Neves RJ, Zincke H. Surgical treatment of renal cancer with vena cava extension. Br J Urol. 1987;59(5):390–5. https://doi.org/10.1111/j.1464-410X.1987.tb04832.x.CrossRefPubMed

Skinner DG, Pfister RF, Colvin R. Extension of renal cell carcinoma into the vena cava: the rationale for aggressive surgical management. J Urol. 1972;107(5):711–6. https://doi.org/10.1016/S0022-5347(17)61122-4.CrossRefPubMed

McDougall E, Clayman RV, Elashry OM. Laparoscopic radical nephrectomy for renal tumor: the Washington university experience. J Uro1. 1996;155:1180–5.CrossRef

Bansal RK, Tu HY, Drachenberg D, et al. Laparoscopic management of advanced renal cell carcinoma with renal vein and inferior vena cava thrombus. Urology. 2014;83(4):812–6. https://doi.org/10.1016/j.urology.2013.09.060.CrossRefPubMed

Hoang AN, Vaporcyian AA, Matin SF. Laparoscopy-assisted radical nephrectomy with inferior vena caval thrombectomy for level II to III tumor thrombus: a single-institution experience and review of the literature. J Endourol. 2010;24(6):1005–12. https://doi.org/10.1089/end.2009.0532.CrossRefPubMed

Abaza R. Initial series of robotic radical nephrectomy with vena caval tumor thrombectomy. Eur Urol. 2011;59(4):652–6. https://doi.org/10.1016/j.eururo.2010.08.038.CrossRefPubMed

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae.CrossRefPubMedPubMedCentral

Conley SP, Humphreys MR, Desai PJ, Castle EP, Dueck AC, Ferrigni RG, et al. Laparoscopic radical nephrectomy for very large renal tumors (>or = 10 cm): is there a size limit? J Endourol. 2009;23(1):57–61. https://doi.org/10.1089/end.2008.0263.CrossRefPubMed

Berger AD, Kanofsky JA, O’ Malley RL, et al. Transperitoneal laparoscopic radical nephrectomy for large (more than 7 cm) renal masses. Urology. 2008;71(3):421–4. https://doi.org/10.1016/j.urology.2007.10.057.CrossRefPubMed

10.

Chan DY, Cadeddu JA, Jarrett TW, Marshall FF, Kavoussi LR. Laparoscopic radical nephrectomy: Cancer control for renal cell carcinoma. J Urol. 2001;166(6):2095–9; discussion 2099-100. https://doi.org/10.1016/S0022-5347(05)65513-9.CrossRefPubMed

11.

Romero FR, Muntener M, Bagga HS, Brito FAR, Sulman A, Jarrett TW. Pure laparoscopic radical nephrectomy with level II vena caval thrombectomy. Urology. 2006;68(5):1112–4. https://doi.org/10.1016/j.urology.2006.08.1084.CrossRefPubMed

12.

Nicolae C, Iulia A, Doru-Lucian G, et al. Dual combined laparoscopic approach for RCC with renal vein and level I-II IVC thrombus - our technique and initial results. J Endourol. 2018;32:837–42.CrossRef

13.

Wang M, Zhang J, Niu Y, Xing N. Feasibility of pure conventional retroperitoneal laparoscopic radical nephrectomy with level II vena caval tumor thrombectomy. Urology. 2016;90:101–4. https://doi.org/10.1016/j.urology.2015.10.037.CrossRefPubMed

14.

Disanto V, Pansadoro V, Portoghese F, Scalese GA, Romano M. Retroperitoneal laparoscopic radical nephrectomy for renal cell carcinoma with infrahepatic vena caval thrombus. Eur Urol. 2005;47(3):352–6. https://doi.org/10.1016/j.eururo.2004.11.010.CrossRefPubMed

15.

Słojewski M. Go1ab a, Petrasz P, Sikorski a. laparoscopic radical nephrectomy for T3b tumor. J Laparoendosc Adv Surg Tech A. 2010;20(1):47–9. https://doi.org/10.1089/lap.2009.0258.CrossRefPubMed

16.

Desai MM, Gill IS, Ramani AP, Matin SF, Kaouk JH, Campero JM. Laparoscopic radical nephrectomy for cancer with level I renal vein involvement. J Urol. 2003;169(2):487–91. https://doi.org/10.1016/S0022-5347(05)63940-7.CrossRefPubMed

17.

Xu B, Zhang Q, Jin J. Wilms tumor with renal vein tumor thrombus treated with only 3-port retroperitoneal laparoscopic technique. Urology. 2013;81(6):1346–8. https://doi.org/10.1016/j.urology.2013.01.023.CrossRefPubMed

18.

Ping H, Xing NZ, Zhang JH, Yan Y, Kang N, Niu YN. Application of the hem-o-lok ligation system in laparoscopic nephrectomy. Surg Endosc. 2010;24(6):1494–7. https://doi.org/10.1007/s00464-009-0782-y.CrossRefPubMed

19.

Shao P, Li J, Qin C, Lv Q, Ju X, Li P, et al. Laparoscopic radical nephrectomy and inferior vena cava thrombectomy in the treatment of renal cell carcinoma. Eur Urol. 2015;68(1):115–22. https://doi.org/10.1016/j.eururo.2014.12.011.CrossRefPubMed

20.

Bratslavsky G, Cheng JS. Robotic-assisted radical nephrectomy with retrohepatic vena caval tumor thrombectomy (level III) combined with extended retroperitoneal lymph node dissection. Urology. 2015;86(6):1235–40. https://doi.org/10.1016/j.urology.2015.05.042.CrossRefPubMed

21.

Ramirez D, Maurice MJ, Cohen B, Krishnamurthi V, Haber GP. Robotic level III IVC tumor thrombectomy: duplicating the open approach. Urology. 2016;90:204–7. https://doi.org/10.1016/j.urology.2016.01.011.CrossRefPubMed

22.

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. https://doi.org/10.1016/j.eururo.2016.08.066.CrossRefPubMed

23.

Wang B, Li H, Huang Q, Liu K, Fan Y, Peng C, et al. Robot-assisted retrohepatic inferior vena cava thrombectomy: first or second porta hepatis as an important boundary landmark. Eur Urol. 2018;74(4):512–20. https://doi.org/10.1016/j.eururo.2017.11.017.CrossRefPubMed

Title: Pure retroperitoneal laparoscopic radical nephrectomy and thrombectomy with delayed occlusion of the proximal inferior vena cava (DOPI) technique for renal tumor with level II-III venous tumor thrombus
Authors: Zhuo Liu
Peng Hong
Guodong Zhu
Li Zhang
Xun Zhao
Shiying Tang
Feilong Yang
Xiaojun Tian
Guoliang Wang
Shudong Zhang
Hongxian Zhang
Yi Huang
Chunxia Liu
Cheng Liu
Lulin Ma
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Nephrectomy
Kidney Cancer
Metastasis
Kidney Cancer
Renal Cancer
Nephrectomy
Kidney Cancer
Nephrectomy
Thrombectomy
Published in: BMC Cancer / Issue 1/2021
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-021-08392-5

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Combined prognostic value of the SUVmax derived from FDG-PET and the lymphocyte-monocyte ratio in patients with stage IIIB-IV non-small cell lung cancer receiving chemotherapy

miR-17-5p drives G2/M-phase accumulation by directly targeting CCNG2 and is related to recurrence of head and neck squamous cell carcinoma

Survival improvement and prognosis for hepatocellular carcinoma: analysis of the SEER database

Genetic and treatment profiles of patients with concurrent Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK) mutations

Modified FOLFIRINOX versus gemcitabine plus oxaliplatin as first-line chemotherapy for patients with locally advanced or metastatic cholangiocarcinoma: a retrospective comparative study

Adverse reactions of targeted therapy in cancer patients: a retrospective study of hospital medical data in China

Keynote webinar | Spotlight on antibody–drug conjugates in cancer