Rosen Geoffrey H, Hargis Paige A, Cunningham Christopher, Pokala Naveen
Division of Urology, Department of Surgery, University of Missouri, Columbia, Missouri, USA.
School of Medicine, University of Missouri, Columbia, Missouri, USA.
J Endourol Case Rep. 2020 Dec 29;6(4):392-395. doi: 10.1089/cren.2020.0062. eCollection 2020.
Renal cell carcinoma (RCC) recurrence can present in nearly any location. Rarely, recurrence is within the venous system. Previous reports of such recurrent tumor thrombectomy have all used an open approach. For the first time, we present robotic excision of recurrent RCC tumor thrombus. This is a 59-year-old man who was referred to us 3 years after right robotic radical nephrectomy and renal vein tumor thrombectomy with positive margins. He had been lost to follow-up after 1 year. He presented again 3 years after surgery and was found to have recurrence with inferior vena cava (IVC) tumor thrombus to the caudal margin of the liver. He was taken for robotic tumor thrombectomy, which was completed with 900 mL of estimated blood loss, requiring a single unit of packed red blood cells. The surgery was complicated by increased bleeding caused by an undiagnosed arteriovenous fistula between the right renal artery and vein remnants. Robotic excision of recurrent RCC IVC thrombus is a potential treatment for selected patients under the care of experienced robotic surgeons.
肾细胞癌（RCC）复发几乎可出现在任何部位。罕见的是，复发发生在静脉系统内。此前关于此类复发性肿瘤血栓切除术的报道均采用开放手术方式。我们首次展示了机器人辅助切除复发性RCC肿瘤血栓的病例。这是一名59岁男性，在接受右侧机器人辅助根治性肾切除术及肾静脉肿瘤血栓切除术后3年，切缘阳性，转诊至我们这里。术后1年他失访了。术后3年他再次就诊，发现下腔静脉（IVC）肿瘤血栓复发至肝尾状缘。他接受了机器人辅助肿瘤血栓切除术，估计失血量为900毫升，需要输注一单单位的浓缩红细胞。手术因右肾动脉与静脉残端之间未被诊断出的动静脉瘘导致出血增加而复杂化。对于在经验丰富的机器人外科医生治疗下的特定患者，机器人辅助切除复发性RCC下腔静脉血栓是一种潜在的治疗方法。
