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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (4): 796-802. doi: 10.19723/j.issn.1671-167X.2025.04.027

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Robot-assisted laparoscopic inferior vena cava segmental resection for renal tumor with tumor thrombus invading the vascular wall

Shuai LIU, Zhuo LIU, Yunhe GUAN, Guoliang WANG, Xiaojun TIAN, Hongxian ZHANG, Lei LIU, Lulin MA, Shudong ZHANG*()   

  1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
  • Received:2025-03-04 Online:2025-08-18 Published:2025-08-02
  • Contact: Shudong ZHANG
  • Supported by:
    the National Natural Science Foundation of China(82273389); Peking University Third Hospital Clinical Key Project(BYSYZD2023035)

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Abstract:

Objective: 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). Methods: 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 (P25, P75), and categorical variables as frequency (percentage). Results: 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 (n=37), Ⅲ (n=6), and Ⅳ (n=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 (n=8) and grade Ⅱ (n=17). Procedure-specific complications included deep vein thrombosis (n=6), transfusion-requiring anemia (n=5), lower extremity edema (n=2), and pulmonary embolism (n=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 (n=12), T3c (n=29), and T4 (n=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 (n=5), hepatic metastasis (n=4), and local recurrence (n=4). Adjuvant therapy regimens comprised targeted-immunotherapy combinations (n=9) and targeted monotherapy (n=18). Conclusion: 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.

Key words: Kidney neoplasms, Tumor thrombus, Inferior vena cava, Segmental resection, Robotic surgical procedures

CLC Number: 

  • R737.11

Figure 1

Surgical procedures of robot-assisted laparoscopic segmental resection of inferior vena cava in the patient with right renal tumor A, clipping and transection of left renal vein; B, linear stapler division of distal inferior vena cava (IVC); C, dissection and exposure of posterior IVC plane; D, transection of right renal artery; E, isolation of short hepatic veins; F, Maryland forceps electrocautery division of second short hepatic vein; G, placement of vascular occlusion tape; H, proximal IVC transection with linear stapler; I, postoperative specimen (blue arrow indicating renal tumor, red arrow showing tumor thrombus)."

Figure 2

Surgical procedures of robot-assisted laparoscopic segmental resection of inferior vena cava in the patient with left renal tumor A, division of left ureter; B, dissection and transection of left renal artery; C, dissection of left renal vein; D, transaction of left renal vein; E, exposure of inferior vena cava (IVC); F, tumor thrombus invades the wall of the vena cava; G, linear stapler division of distal IVC; H, proximal IVC transection with linear stapler; I, proximal IVC transection with linear stapler."

Table 1

Patient characteristics of robot-assisted laparoscopic segmental resection of the inferior vena cava (n=44)"
Items Data
Age/years, median (P25, P75) 62 (55, 68)
Male, n(%) 31 (70.5)
Body mass index, median (P25, P75) 24.5 (22.1, 27.3)
Side, n(%)
  Left 5 (11.4)
  Right 39 (88.6)
Size/cm, median (P25, P75) 8.1 (6.1, 10.1)
Mayo classification, n(%)
  Ⅰ 0 (0)
  Ⅱ 37 (84.1)
  Ⅲ 6 (13.6)
  Ⅳ 1 (2.3)
ASA class, n(%)
  Ⅰ 2 (4.5)
  Ⅱ 28 (63.6)
  Ⅲ 14 (31.8)
Operative time/min, median (P25, P75) 224.0 (167.3, 303.8)
Estimated blood loss/mL, median (P25, P75) 500.0 (300.0, 850.0)
Patients receiving transfusion, n(%) 19 (43.2)
Lymph node dissection, n(%) 29 (65.9)
Adrenalectomy, n(%) 31 (70.5)
Postoperative hospital stay/d, median (P25, P75) 6 (5, 8)
Preoperative serum creatinine/(μmol/L), median (P25, P75) 102.5 (82.3, 115.3)
Postoperative serum creatinine/(μmol/L), median (P25, P75) 116.0 (86.5, 157.5)
Venous tumor thrombus combined with bland thrombus, n(%) 17 (38.6)
Histological type, n(%)
  Clear cell renal cell carcinoma 34 (77.3)
  Papillary renal cell carcinoma 2 (4.5)
  Unclassified renal cell carcinoma 2 (4.5)
  Spindle cell sarcoma 1 (2.3)
  Leiomyosarcomas 1 (2.3)
  TFE3-rearranged renal cell carcinoma 1 (2.3)
  Fumarate hydratase-deficient renal cell carcinoma 1 (2.3)
  Indeterminate histology due to treatment response 2 (4.5)
Four-tiered WHO/ISUP grading system, n(%)
  Ⅰ 1 (2.3)
  Ⅱ 8 (18.2)
  Ⅲ 10 (22.7)
  Ⅳ 15 (34.1)
  Not graded 10 (22.7)
T stage, n(%)
  T3b 12 (27.3)
  T3c 29 (65.9)
  T4 3 (6.8)
N1, n(%) 8 (18.2)
M1, n(%) 17 (38.6)
Adrenal metastasis, n(%) 3 (6.8)
Invade the wall of the vena cava, n(%) 36 (81.8)
Complication, n(%) 25 (56.8)
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