Liu S, Liu Z, Guan Y, Wang G, Tian X, Zhang H, Liu L, Ma L, Zhang S
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2025 Aug 18;57(4):796-802. doi: 10.19723/j.issn.1671-167X.2025.04.027.
To evaluate the safety and oncological outcomes of robot-assisted laparoscopic inferior vena cava (IVC) segmental resection in renal tumor with IVC tumor thrombus (IVCTT).
Clinical data from renal tumor patients undergoing robot-assisted laparoscopic IVC segmental resection at Peking University Third Hospital from Jan. 2021 to Feb. 2025 were retrospectively analyzed. Data collection included baseline demographics, tumor characteristics, perioperative parameters, and follow-up outcomes. Surgical records and pathological reports were retrieved from the electronic medical record system. Continuous variables were presented as median (, ), and categorical variables as frequency (percentage).
Forty-four patients were enrolled. The cohort comprised 31 males and 13 females, with a median age of 62 (55, 68) years. Right-sided tumors were observed in 39 cases and left-sided in 5 cases. Median tumor diameter was 8.1 (6.1, 10.1) cm. Mayo classifications included grade Ⅱ (=37), Ⅲ (=6), and Ⅳ (=1). Neoadjuvant therapy was administered to 23 patients. Seventeen patients were complicated by IVC bland thrombus. Median operative time was 224.0 (167.3, 303.8) min, with intraoperative blood loss of 500.0 (300.0, 850.0) mL. Transfusion was administered to 19 patients, with a median blood transfusion of 800.0 (400.0, 1 200.0) mL. Postoperative complications occurred in 25 cases (56.8%), classified as Clavien-Dindo grade Ⅰ (=8) and grade Ⅱ (=17). Procedure-specific complications included deep vein thrombosis (=6), transfusion-requiring anemia (=5), lower extremity edema (=2), and pulmonary embolism (=2), with no procedure- related mortality. Median postoperative serum creatinine was 116.0 (86.5, 157.5) μmol/L. Pathological examination identified clear cell renal cell carcinoma as the predominant subtype, observed in 34 cases (77.3%). Pathological staging revealed T3b (=12), T3c (=29), and T4 (=3) disease, with nodal involvement (N1) in 8 cases and distant metastasis (M1) in 17. At a median follow-up of 10 months (range: 1-49 months), cancer-specific mortality occurred in 3 patients, while 1 succumbed to other causes. Disease progression included pulmonary metastasis (=5), hepatic metastasis (=4), and local recurrence (=4). Adjuvant therapy regimens comprised targeted-immunotherapy combinations (=9) and targeted monotherapy (=18).
Robot-assisted laparoscopic IVC segmental resection achieves precise thrombus removal with confirmed short-term efficacy in renal tumor with IVCTT, though vigilance against vascular complications remains critical.
评估机器人辅助腹腔镜下肾肿瘤合并下腔静脉瘤栓（IVCTT）患者行下腔静脉节段性切除术的安全性及肿瘤学结局。
回顾性分析2021年1月至2025年2月在北京大学第三医院接受机器人辅助腹腔镜下IVC节段性切除术的肾肿瘤患者的临床资料。数据收集包括基线人口统计学、肿瘤特征、围手术期参数及随访结果。从电子病历系统中检索手术记录和病理报告。连续变量以中位数（，）表示，分类变量以频数（百分比）表示。
共纳入44例患者。该队列包括31例男性和13例女性，中位年龄为62（55，68）岁。右侧肿瘤39例，左侧肿瘤5例。肿瘤中位直径为8.1（6.1，10.1）cm。梅奥分级包括Ⅱ级（=37）、Ⅲ级（=6）和Ⅳ级（=1）。23例患者接受了新辅助治疗。17例患者合并下腔静脉白血栓。中位手术时间为224.0（167.3，303.8）分钟，术中失血500.0（300.0，850.0）毫升。19例患者接受输血，中位输血量为800.0（400.0，1200.0）毫升。25例（56.8%）发生术后并发症，分类为Clavien-DindoⅠ级（=8）和Ⅱ级（=17）。特定手术并发症包括深静脉血栓形成（=6）、需要输血的贫血（=5）、下肢水肿（=2）和肺栓塞（=2），无手术相关死亡。术后血清肌酐中位数为116.0（86.5，157.5）μmol/L。病理检查确定透明细胞肾细胞癌为主要亚型，共34例（77.3%）。病理分期显示为T3b（=12）、T3c（=29）和T4（=3）期疾病，8例有淋巴结转移（N1），17例有远处转移（M1）。中位随访10个月（范围：1 - 49个月），3例患者发生癌症特异性死亡，1例死于其他原因。疾病进展包括肺转移（=5）、肝转移（=4）和局部复发（=4）。辅助治疗方案包括靶向免疫联合治疗（=9）和靶向单药治疗（=18）。
机器人辅助腹腔镜下IVC节段性切除术可精确清除瘤栓，对肾肿瘤合并IVCTT患者有确切的短期疗效，尽管警惕血管并发症仍至关重要。
