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Review
. 2023 Mar 31;11(6):262.
doi: 10.21037/atm-22-2877. Epub 2023 Feb 10.

The surgical evolution of radical nephrectomy and tumor thrombectomy: a narrative review

Marina M Tabbara  1   2 , Javier González  3 , Gaetano Ciancio  1   2   4
Affiliations
Review

The surgical evolution of radical nephrectomy and tumor thrombectomy: a narrative review

Marina M Tabbara et al. Ann Transl Med. .

Abstract

Background and objective: Renal cell carcinoma (RCC) accounts for 2-3% of all malignant disease in adults. RCC propagates into the renal vein and inferior vena cava (IVC) in up to 25% of patients with RCC. Despite advances in medical management such as immunotherapy, surgical resection remains the gold standard treatment of RCC with venous tumor thrombus (TT) extension. Surgical innovation has revolutionized the management of RCC with TT, reducing morbidity and mortality through advanced surgical techniques and minimally invasive approaches. The aim of this review is to summarize the evolving developments in the surgical treatment of RCC with venous TT.

Methods: We performed an advanced search on PubMed between the inception of the database and April 2022 to summarize the evolution of the surgical management of RCC with venous TT, focusing on the reports of key historical, current, and recent studies.

Key content and findings: Implementation of entirely intraabdominal liver transplant-based approaches have allowed for successful surgical excision of higher-level tumor thrombi, obviating the need for sternotomy or cardiopulmonary bypass (CPB). Recent advances in robotic surgery provide a promising approach for minimally invasive management of RCC with venous TT extension.

Conclusions: Surgical innovation has revolutionized the management of RCC with TT, reducing morbidity and mortality through minimally invasive techniques with preserved oncologic effectiveness.

Keywords: Renal cell carcinoma; nephrectomy; surgical technique; thrombectomy; tumor thrombus.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-2877/coif). GC serves as an unpaid editorial board member of Annals of Translational Medicine from November 2021 to October 2023. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
A diagram showing the surgical maneuvers recommended in various scenarios of RCC with IVC TT according to the University of Miami thrombus level classification system. CPB, cardiopulmonary bypass; IVC, inferior vena cava; TT, tumor thrombus; MHV, middle hepatic vein; RV, renal vein; RCC, renal cell carcinoma.
See this image and copyright information in PMC

References

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