Abstract：
Renal cell carcinoma accounts for two to three percent of adult malignancies and can lead to inferior vena cava (IVC) thrombosis. This condition can decrease the rate of 5-year survival for patients to 60%. The treatment of choice in such cases is radical nephrectomy and inferior vena cava thrombectomy. This surgery is one of the most challenging due to many perioperative complications. There are many controversial methods reported in the literature. Achieving the free of tumor IVC wall and the possibility of thrombectomy in cases of level III and level IV IVC thrombosis are two essential matters previously advocated open approaches. Nevertheless, open approaches are being replaced by minimally invasive techniques despite the difficulty of the surgical management of IVC thrombectomy. This paper aims to review recent evidence about new surgical methods and a comparison of open, laparoscopic, and robotic approaches. In this review, we present the latest surgical strategies for IVC thrombectomy and compare open and minimally invasive approaches to achieve the optimal surgical technique. Due to the different anatomy of the left and right kidneys and variable extension of venous thrombosis, we investigate surgical methods for left and right kidney cancer and each level of IVC venous thrombosis separately.
摘要：
肾细胞癌占成人恶性肿瘤的2％至3％，并可导致下腔静脉（IVC）血栓形成。这种情况可以将患者的5年生存率降低到60％。在这种情况下，选择的治疗方法是根治性肾切除术和下腔静脉血栓切除术。由于许多围手术期并发症，该手术是最具挑战性的手术之一。文献中报道了许多有争议的方法。在III级和IV级IVC血栓形成的情况下，实现无肿瘤IVC壁和血栓切除术的可能性是先前提倡的两个基本问题。然而，尽管IVC血栓切除术的外科治疗存在困难,但微创技术正在取代开放入路.本文旨在回顾有关新手术方法的最新证据以及开放手术方法的比较，腹腔镜,和机器人方法。在这次审查中,我们介绍了IVC血栓切除术的最新手术策略,并比较了开放和微创方法,以获得最佳的手术技术.由于左、右肾的解剖结构不同,静脉血栓的延伸性不同,我们分别探讨左右肾癌的手术方法和各级IVC静脉血栓形成。
