Shah Mihir S, Wang Kerith R, Shah Yash B, Ragam Radhika, Simhal Rishabh K, Ghodoussipour Saum, Djaladat Houman, Mark James R, Lallas Costas D, Chandrasekar Thenappan
Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Department of Urology, Oschner Health, New Orleans, LA 70121, USA.
J Clin Med. 2024 Feb 26;13(5):1308. doi: 10.3390/jcm13051308.
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.
肾细胞癌（RCC）是一种常见的诊断疾病，其中相当一部分患者表现为肿瘤延伸至静脉循环，导致下腔静脉（IVC）肿瘤血栓形成。静脉延伸对分期和后续治疗计划具有重要意义，建议进行更积极的手术切除，尽管相关的手术并发症和死亡率相对增加。手术切除伴有IVC血栓的RCC的方法仍然复杂，特别是在机器人辅助手术的应用方面。在这种情况下，机器人辅助根治性肾切除术最近才出现。血栓水平对手术技术和预后具有重要意义。其他术前考虑因素可能包括位置、侧别、大小和壁侵犯。关于此类肿瘤治疗的泌尿外科文献很大程度上局限于病例系列和机构研究，这些研究描述了针对这些复杂肿瘤的各种手术选择的可行性。对结果和患者特异性风险因素的进一步了解将为这类病例的最佳治疗提供更多启示。这篇叙述性综述全面概述了先前报道的机器人辅助肾切除术在伴有IVC血栓的RCC中的应用，以为进一步的研究提供参考，这些研究可能会优化结果并指导共同决策。
