Robotic Surgery for Renal Cell Carcinoma with Vena Caval Tumor Thrombus

Abstract

Context: Robotic surgery has significantly advanced the minimally-invasive management of kidney tumors with extension into the inferior vena cava requiring caval cross-clamping and tumor thrombectomy. Additional techniques have recently been developed to continue the evolution of this complex procedure and extend its indications.

Objective: To review the current state of the art as regards robotic nephrectomy with inferior vena cava thrombectomy (RNIT).

Evidence acquisition: A systematic review of the Medline database was performed. All literature available through October 2016 was included.

Evidence synthesis: RNIT has been successfully adopted at select centers, but the number of patients reported to date remains limited. Modifications in clamping and tumor thrombus management have been described allowing for multiple options in surgical technique. Early perioperative outcomes appear favorable in comparison with traditional, open surgery, but further experience is needed.

Conclusions: Feasibility and reproducibility of RNIT has been demonstrated, but longer-term outcomes and larger patient numbers are necessary before the role of this procedure is established.

Patient summary: Kidney cancers invading the largest vein in the body, the vena cava, require complex surgery for removal. Traditionally this has required a large incision, but newer techniques with robotic surgery that continue to evolve have allowed for a minimally-invasive approach.

Keywords: Inferior vena cava; Nephrectomy; Renal cancer; Robotics; Thrombus.