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. 2022 Feb 7;22(1):151.
doi: 10.1186/s12885-022-09235-7.

Step-by-step and orderly lowering of the height of inferior vena cava tumor thrombus is the key to robot-assisted thrombectomy for Mayo III/IV tumor thrombus

Guo-Dong Zhao #  1 , Xiu-Ping Zhang #  1 , Ming-Gen Hu #  1 , Qing-Bao Huang #  2 , Shuai Xu  1   3 , Bao-Jun Wang  2 , Xin Ma  2 , Xu Zhang  2 , Wen-Bo Zou  1 , Xuan Zhang  1 , Zhi-Ming Zhao  1 , Xiang-Long Tan  1 , Sai Chou  1 , Gang Wang  1 , Rong Liu  4   5
Affiliations

Step-by-step and orderly lowering of the height of inferior vena cava tumor thrombus is the key to robot-assisted thrombectomy for Mayo III/IV tumor thrombus

Guo-Dong Zhao et al. BMC Cancer. .

Abstract

Background: The surgical management of Mayo III/IV tumor thrombi is difficult and risky, and robotic surgery is even more difficult. The purpose of this study was to introduce the step-by-step and orderly lowering of the height of inferior vena cava tumor thrombus, which was the core technique of robot operation for Mayo III/IV tumor thrombus.

Method: A total of 18 patients were included in this study. The average tumor thrombus height was 2.4 cm above the level of the second porta hepatis (SPH), and 9 patients were prepared for cardiopulmonary bypass (CPB) before surgery. During the operation, the height of the tumor thrombus was lowered orderly for 2-3 times, and the blood flow blocking method was changed sequentially. The CPB was required when tumor thrombus in the atrium; After the height of the thrombus was lowered to the atrium entrance, CPB was stopped and the blood flow was blocked in the upper- and retro-hepatic inferior vena cava (IVC); After the tumor thrombus continued to descend to the lower part of the SPH, liver blood flow could be restored, and then, the blood flow was simply blocked in the retro-hepatic IVC to complete the removal of the thrombus and the repair or resection of the IVC. Finally, the diseased kidney and renal vein were removed.

Results: All operations were successfully completed, and 2 cases were transferred to laparotomy. Seven cases received CPB, while the other 11 did not. 15 patients underwent two times of the lowering of the tumor thrombus, 2 patients underwent one time and 1 patient underwent three times. The mean liver/IVC dissociation and vascular suspension time was 22.0 min. All patients had less than Clavien-Dindo grade III complications, no serious complications occurred during operation, and no patient died within 90 days.

Conclusions: The step-by-step and orderly decline of tumor thrombus height is the key to the success of robot Mayo III / IV tumor thrombus surgery. This method can shorten FPH and CPB time and improve the success rate of surgery.

Keywords: Inferior vena cava tumor thrombus; Mayo III/IV level; Robot-assisted thrombectomy; Step-by-step and orderly.

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Conflict of interest statement

No potential conflicts of interest were disclosed.

Figures

Fig. 1
Fig. 1
A The conventional port placements of robotic liver surgery; High segment of liver of the IVC were dissociated in “left-right-superior” order. B The left short hepatic vessel was severed successively to the level of the second porta hepatis (SPH) (left). C After that, the right triangular ligament, coronal ligament and hepatorenal ligament were incised in turn (right). D Opening the fibrous connection between the diaphragm and the inferior vena cava, entered the mediastinum from the foot side. E if necessary, the ventral diaphragm and pericardium of the second hepatic hilum were opened longitudinally to expose the IVC, atrium and ventricle of the whole liver atrium, then dissociated the suprahepatic and subatrial segments of the IVC
Fig. 2
Fig. 2
Two examples of patients with different level IVCTT were shown (A 1.63cm beyond diaphragmatic level; B 3.45cm beyond diaphragmatic level)
Fig. 3
Fig. 3
Suggestions on revision of Mayo classification
See this image and copyright information in PMC

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