Department of Urology, University of Texas Health, San Antonio, Texas.
Department of Urology, University of Washington, Seattle, Washington.
J Urol. 2022 Sep;208(3):542-560. doi: 10.1097/JU.0000000000002829. Epub 2022 Sep 1.
Open radical nephrectomy with inferior vena cava thrombectomy (O-CT) is standard management for renal cell carcinoma with inferior vena cava thrombus. First reported a decade ago, robotic-assisted radical nephrectomy with inferior vena cava thrombectomy (R-CT) is a minimally invasive option for this disease. W 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 Science 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 search 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 the 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.
开放式根治性肾切除术联合下腔静脉取栓术（O-CT）是肾细胞癌合并下腔静脉血栓的标准治疗方法。机器人辅助下腔静脉取栓术（R-CT）是一种微创选择，十年前首次报道。我们旨在进行系统评价，以评估 R-CT 在围手术期结局方面的安全性和可行性，并比较 R-CT 和 O-CT 的结局。
使用自由文本和 MeSH 术语“肾细胞癌”、“下腔静脉”、“血栓形成”或“血栓”、“机器人”和“取栓术”在 PubMed、Scopus、Cochrane 中央对照试验注册库和 Web of Science 数据库中进行搜索。纳入报告 R-CT 围手术期结果的研究和比较 R-CT 与 O-CT 的研究。该综述符合 PRISMA（系统评价和荟萃分析的首选报告项目）指南。
检索到 28 篇描述 R-CT 的文章，其中包括 7 项比较研究。本系统评价共纳入 1375 例患者，其中 329 例为单臂研究，1046 例为比较研究。在接受 R-CT 的 329 例患者中，14.7%为 I 级，60.9%为 II 级，20.4%为 III 级，2.5%为 IV 级血栓。手术时间为 150-530 分钟；38.2%（126 例）输血。总体并发症发生率为 30.3%（99 例）。与 O-CT 相比，R-CT 的输血率较低（18.4%比 64.3%，p=0.002），并发症发生率较低（14.5%比 36.7%，p=0.005）。两组主要并发症和 30 天死亡率相似。
在精心挑选的患者中，R-CT 的围手术期结果可以接受。与 O-CT 相比，R-CT 输血率较低，总体并发症较少。在经验丰富的医生精心挑选的患者中，R-CT 是可行和安全的，具有可接受的结果；然而，选择偏倚限制了这些结果的明确推断，最佳的患者选择标准仍有待描述。
