nach oben

World Journal of Urology

Erschienen in:

05.03.2020 | Original Article

Role of intraoperative ultrasound in robotic-assisted radical nephrectomy with inferior vena cava thrombectomy in renal cell carcinoma

verfasst von: Qiuyang Li, Nan Li, Yukun Luo, Hongkai Yu, Xin Ma, Xu Zhang, Jie Tang

Erschienen in: World Journal of Urology | Ausgabe 12/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To determine the impact of intraoperative ultrasound on robotic-assisted radical nephrectomy with inferior vena cava (IVC) tumor thrombectomy in renal cell carcinoma (RCC).

Methods

We retrospectively analyzed intraoperative records of 27 patients with RCC and invasion of the IVC who underwent robotic-assisted nephrectomy with tumor thrombectomy at our center between December 2017 and July 2018. Diagnostic utility and impact of intraoperative transesophageal echocardiography (TEE), intraoperative robotic-assisted ultrasonography, and intraoperative contrast-enhanced ultrasound (CEUS) on surgical management were extracted from the surgical notes and intraoperative ultrasound reports.

Results

Twenty-seven patients with thrombus had intraoperative ultrasound. Complete tumor removal was achieved in 22 patients, IVC transection in 5 patients, and no residual tumor was observed in all patients. Intraoperative TEE changed the robotic surgical strategy in three patients by monitoring thrombus-level regression. Downstaging of the thrombus level occurred in three patients: Levels IV to III in one and Levels III to II in two. Intraoperative robotic-assisted ultrasonography has facilitated safe VC clamp placement and identification and protection of collateral vessels during IVC transection in five patients. Intraoperative CEUS helped to differentiate the boundary between tumor thrombus (enhancement and small vessel pulsation) and bland thrombus (hypoechoic or no enhancement) in eight (29.6%) patients with bland thrombus.

Conclusions

Intraoperative ultrasound is a safe, minimally invasive technique that can provide accurate real-time information regarding the presence and extent of IVC involvement and guidance for placement of a vena cava clamp, confirming the character of the thrombus to plan an optimal surgical approach.

Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H (2004) The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int 94:33–41CrossRef

Romero FR, Muntener M, Bagga HS, Brito FAR, Sulman A, Jarrett TW (2006) Pure laparoscopic radical nephrectomy with level II vena caval thrombectomy. Urology 68:1112–1114CrossRef

Martin GL, Castle EP, Martin AD, Desai PJ, Lallas CD, Ferrigni RG et al (2008) Outcomes of laparoscopic radical nephrectomy in the setting of vena caval and renal vein thrombus: seven-year experience. J Endourol 22:1681–1685CrossRef

Wang W, Wang L, Xu J, Tian Y, Lv W (2014) Pure retroperitoneal laparoscopic radical nephrectomy for right renal masses with renal vein and inferior vena cava thrombus. J Endourol 28:819–824CrossRef

Wang W, Xu J, Adams TS, Tian Y, Lv W (2014) Pure retroperitoneal laparoscopic radical nephrectomy for left renal call carcinoma with differential extensions of level I renal vein rumor thrombus. J Endourol 28:312–317CrossRef

Hoang AN, Vaporcyian AA, Matin SF (2010) Laparoscopy-assisted radical nephrectomy with inferior vena caval thrombectomy for level II to III tumor thrombus: a single-institution experience and review of the literature. J Endourol 24:1005–1012CrossRef

Wang B, Li H, Ma X, Zhang X, Gu L, Li X et al (2016) Robot-assisted laparoscopic inferior vena cava thrombectomy: different sides require different techniques. Eur Urol 69:1112–1119CrossRef

Wang B, Li H, Huang Q, Liu K, Fan Y, Peng C et al (2018) Robot-assisted retrohepatic inferior vena cava thombectomy: first or second porta hepatis as an important boundary landmark. Eur Urol 74:512–520CrossRef

Wang B, Huang Q, Liu K et al (2019) Robot-assisted Level III–IV inferior vena cava thrombectomy: initial series with step-by-step procedures and 1-yr outcomes. Eur Urol. https://doi.org/10.1016/j.eururo.2019.04.019CrossRefPubMedPubMedCentral

10.

Gu L, Ma X, Gao Y, Li H, Li X, Chen L et al (2017) Robot-versus open level I–II inferior Vena Cava thrombectomy: a matched group comparative analysis. J Urol 198:1241–1246CrossRef

11.

Adams LC, Ralla B, Bender YY et al (2018) Renal cell carcinoma with venous extension: prediction of inferior vena wall invasion by MRI. Cancer Imaging 18(1):17CrossRef

12.

Aslam Sohaib SA, The J, Nargund VH et al (2002) Assessment of tumor invasion of the vena caval wall in renal cell carcinoma cases by magnetic resonance imaging. J Urol 167:1271–1275CrossRef

13.

Stern PR, Perkov D, Smiljanic R et al (2007) Venous spread of renal cell carcinoma: MDCT. Abdom Imading 32(4):530–537CrossRef

14.

Hutchinson R, Rew C, Chen G et al (2018) The adverse survival implications of bland thrombus in renal cell carcinoma with venous tumor thrombus. Urology 115:119–124CrossRef

15.

Matin SF, Gill IS (2001) Laparoscopic ultrasonography. J Endourol 15:87–92CrossRef

16.

O^,Neal D, Cohen T, Peterson C, Barr RG. Contrast-enhanced ultrasound-guided radiofrequency ablation of renal tumors. J Kidney Cancer VHL 2018;5:7–14

17.

Alenezi AN, Karim O (2015) Role of intra-operative contrast-enhanced ultrasound (CEUS) in robotic-assisted nephron-sparing surgery. J Robot Surg 9:1–10CrossRef

18.

Alenezi A, Motiwala A, Eves S, Gray R, Thomas A, Meiers I et al (2017) Robotic assisted laparoscopic partial nephrectomy using contrast-enhanced ultrasound scan to map renal bold flow. Int J Med Robot 13:e1738CrossRef

19.

Liu B, Zhan Y, Chen X, Xie Q, Wu B (2018) Laparoscopic ultrasonography: the wave of the future in renal cell carcinoma? Endosc Ultrsound 7:161–167CrossRef

20.

Steinnerd LE, Vardi IY, Bhayani SB (2007) Laparoscopic radical nephrectomy for renal carcinoma with known level I renal vein tumor thrombus. Uroloy 69:662–665CrossRef

21.

Hekma MC, Rijpkema M, Langenhuijsen JF, Boerman OC, Oosterwijk E, Mulders PFA. Intraoperative imaging techniques to support complete tumor resection in partial nephrectomy. Eur Urol Focus 2017. Pii:S2405-4569(17):30114-1

22.

Wang M, Ping H, Niu Y, Zhang J, Xing N (2014) Pure conventional laparoscopic radical nephrectomy with level vena cava tumor thrombectomy. Int Br J Urol 40:266–273CrossRef

23.

Yang R, Lian H, Zhang G, Wang W, Gan W, Li X et al (2014) Laparoscopic radiofrequency ablation with intraoperative contrast-enhanced ultrasonography for T1bN0M0 renal tumors: initial functional and oncologic outcomes. J Endourol 28:4–9CrossRef

24.

Badger WJ, de Araujo HA, Kuehn DM, Angresen KJ, Winfield HN (2009) Laparoscopic renal tumor cryoablation: appropriate application of real-time ultrasonographic monitoring. J Endourol 23:427–430CrossRef

25.

Day D, Kanjanapan Y, Kwan E et al (2016) Benefit from cytoreductive nephrectomy and the prognostic role of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma. Int Med J 46(11):1291–1297CrossRef

26.

Sakai I, Miyake H, Hinata N et al (2014) Improved survival in patients with metastatic renal cell carcinoma undergoing cytoreductive nephrectomy in the era of targeted therapy. Int J Chin Oncol 19(4):674–678CrossRef

27.

Bex A, Albiges L, Ljungberg B et al (2018) Updated European Association of urology guidelines for cytoreductive nephrectomy in patients with synchronous metastatic clear-cell renal cell carcinoma. Eur Urol 74(6):805–809CrossRef

28.

Oikawa T, Shimazui T, Johraku A, Kihara S, Tsukamoto S, Miyanaga N et al (2004) Intraoperative transesophageal echocardiography for inferior vena caval tumor thrombus in renal cell carcinoma. Int J Urol 11:189–192CrossRef

29.

Kostibas MP, Arora V, Gorin MA, Ball MW, Pierorazion PM, Allaf ME et al (2017) Defining the role of intraoperative transesohpageal echocardiography during radical nephrectomy with inferior Vena Cava tumor thrombectomy for renal cell carcinoma. Urology 107:161–165CrossRef

30.

Kaczmarek BF, Sukumar S, Kumar RK, Desa N, Jost K, Diaz M et al (2013) Comparison of robotic and laparoscopic ultrasound probes for robotic partial nephrectomy. J Endourol 27:1137–1140CrossRef

31.

Kaczmarek BF, Sukumar S, Petros F, Trinh QD, Mander N, Chen R et al (2013) Robotic ultrasound probe for tumor identification in robotic partial nephrectomy: Initial series and outcomes. Int J Urol 20:172–176CrossRef

32.

Lee A (2008) VTE in patients with cancer-diagnosis, prevention and treatment. Thromb Res 123(Suppl. 1):S50–S54CrossRef

33.

Lambert EH, Pierorazio PM, Shabsigh A, Olsson CA, Benson MC, McKiernan JM (2007) Prognostic risk stratification and clinical outcomes in patients undergoing surgical treatment for renal cell carcinoma with vascular tumor thrombus. Urology 69:1054CrossRef

34.

Hutchinson R, Rew C, Chen G, Wodu S, Krabbe LM, Meissner M et al (2018) The adverse survival implications of bland thrombus in renal cell carcinoma with venous tumor thrombus. Urology 115:119–124CrossRef

Titel: Role of intraoperative ultrasound in robotic-assisted radical nephrectomy with inferior vena cava thrombectomy in renal cell carcinoma
verfasst von: Qiuyang Li
Nan Li
Yukun Luo
Hongkai Yu
Xin Ma
Xu Zhang
Jie Tang
Publikationsdatum: 05.03.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 12/2020
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-020-03141-y

Neu im Fachgebiet Urologie

Adjuvante Immuntherapie verlängert Leben bei RCC

25.04.2024 Nierenkarzinom Nachrichten

Nun gibt es auch Resultate zum Gesamtüberleben: Eine adjuvante Pembrolizumab-Therapie konnte in einer Phase-3-Studie das Leben von Menschen mit Nierenzellkarzinom deutlich verlängern. Die Sterberate war im Vergleich zu Placebo um 38% geringer.

Bei Senioren mit Prostatakarzinom auf Anämie achten!

24.04.2024 DGIM 2024 Nachrichten

Patienten, die zur Behandlung ihres Prostatakarzinoms eine Androgendeprivationstherapie erhalten, entwickeln nicht selten eine Anämie. Wer ältere Patienten internistisch mitbetreut, sollte auf diese Nebenwirkung achten.

Stufenschema weist Prostatakarzinom zuverlässig nach

22.04.2024 Prostatakarzinom Nachrichten

Erst PSA-Test, dann Kallikrein-Score, schließlich MRT und Biopsie – ein vierstufiges Screening-Schema kann die Zahl der unnötigen Prostatabiopsien erheblich reduzieren: Die Hälfte der Männer, die in einer finnischen Studie eine Biopsie benötigten, hatte einen hochgradigen Tumor.

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

20.04.2024 EAU 2024 Kongressbericht

Beim chronischen Harnwegsinfekt bei Frauen wird bisher meist eine Antibiotikaprophylaxe eingesetzt. Angesichts der zunehmenden Antibiotikaresistenz erweist sich das Antiseptikum Methenamin-Hippurat als vielversprechende Alternative, so die Auswertung einer randomisierten kontrollierten Studie.

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 12/2020

RE: The evaluation of early predictive factors for urosepsis in patients with negative preoperative urine culture following mini-percutaneous nephrolithotomy

Urine routine tests: a guideline-neglected, but indispensable investment in stone-removing endourological procedures

Long-term outcomes of anastomotic urethroplasty for radiation-induced strictures

Reply letter to: Comments to "Systematic review and cumulative analysis of the managements for proximal impacted ureteral stones" by Gao ZY