PDF(Pubmed)
Abstract：
UNASSIGNED: Renal cell carcinoma is one common type of urologic cancers. It has tendencies to invade into the inferior vena cava (IVC) and usually requires an open surgery procedure. High rates of operative complications and mortality are usually associated with an open surgery procedure. The recently emerged robot-assisted laparoscopic radical nephrectomy (RAL-RN) and IVC tumor thrombectomy have shown to reduce operative related complications in patients with renal cell carcinoma.This case series study aimed to summarize technical utilization, perioperative outcomes, and efficacies of RAL-RN and IVC tumor thrombectomy in our hospital. A retrospective analysis was performed on clinical data from 20 patients who underwent RAL-RN and IVC tumor thrombectomy from January 2017 to December 2019 in our department.Patients had a median age of 59 years (interquartile range [IQR], 46-68). Four patients had renal neoplasm on left side and 16 on right side. Nineteen patients underwent RAL-RN (level 0: n = 2) or RAL-RN with IVC thrombectomy (n = 17) (level I: n = 3; level II: n = 12; and level III: n = 3) and 1 patient was converted into an open surgery. The median operative time was 328 minutes (IQR, 221-453). The estimated median blood loss was 500 mL (IQR, 200-1200). The median size of removed renal carcinoma was 67 cm2 (IQR, 40-91); the length of IVC tumor thrombus was 5 cm (IQR, 3-7). The postsurgery hospital length of stay was 6 days (IQR, 5-7). The complications included intestinal obstruction (n = 1), lymphatic fistula (n = 1), heart failure (n = 1), and low hemoglobin level (n = 1). The outcomes for patients after 16 months (IQR, 11-21) follow-up were tumor-free (n = 10), tumor progression (n = 4), loss of contact (n = 1), and death (n = 5).We concluded that RAL-RN and IVC thrombectomy renders good safety profiles including minimal invasiveness, low estimated median blood loss, short hospitalization, low morbidity, and quick renal function recovery. The long-term efficacy needs a further investigation.
摘要：
未经证实：肾细胞癌是一种常见的泌尿系肿瘤。它有侵入下腔静脉（IVC）的倾向，通常需要开放的外科手术。手术并发症和死亡率高通常与开放手术有关。最近出现的机器人辅助腹腔镜根治性肾切除术（RAL-RN）和IVC肿瘤血栓切除术已显示出减少肾细胞癌患者手术相关并发症的方法。本案例系列研究旨在总结技术利用，围手术期结局,我院RAL-RN和IVC癌栓切除术的疗效。回顾性分析2017年1月至2019年12月在我科接受RAL-RN和IVC癌栓切除术的20例患者的临床资料。患者的平均年龄为59岁(四分位距[IQR]，46-68).左侧有4例肾脏肿瘤，右侧有16例。19例患者接受了RAL-RN（0级：n=2）或RAL-RN并进行了IVC血栓切除术（n=17）（I级：n=3；II级：n=12；III级：n=3），1例患者接受了开放手术。中位手术时间为328分钟（IQR，221-453）。估计的中位失血量为500mL(IQR，200-1200)。切除的肾癌的中位大小为67cm2(IQR，40-91)；IVC癌栓长度为5cm(IQR，3-7).术后住院时间为6天(IQR，5-7).并发症包括肠梗阻（n=1），淋巴瘘（n=1），心力衰竭（n=1），和低血红蛋白水平（n=1）。16个月后患者的结果(IQR，11-21)随访无肿瘤(n=10)，肿瘤进展（n=4），失去接触(n=1)，死亡（n=5）。我们得出的结论是，RAL-RN和IVC血栓切除术具有良好的安全性，包括最小的侵入性，低估计中位失血量，短期住院，低发病率，肾功能恢复快.长期疗效有待进一步研究。
