title: Multi-Institutional Experience with Robotic Nephrectomy with Inferior Vena Cava Tumor Thrombectomy.
abstract: Since the first report of robotic management of renal tumors with inferior vena cava tumor thrombi, few additional cases have been reported in the literature. We report our combined experience with this procedure, to our knowledge the first multi-institutional and largest series reported to date.
  
  
  
  A retrospective, multi-institutional review of robotic nephrectomy with inferior vena cava tumor thrombectomy was performed with institutional review board approval.
  
  
  
  A total of 32 cases were performed among 9 surgeons at 9 institutions since the first known procedure in 2008. Of these cases 30 were level II and 2 were level III thrombi with no level I thrombi (renal vein only) included in the analysis. Each surgeon performed between 1 and 10 procedures. Mean patient age was 63 years (range 43 to 81) with a mean body mass index of 30 kg/m(2) (range 17 to 43) and mean maximal tumor diameter of 9.6 cm (range 5.4 to 20). The length of inferior vena cava tumor thrombi ranged from 1 to 11 cm (median 4.2) on preoperative imaging. The inferior vena cava required cross-clamping in 24 cases. One patient had 2 renal veins with 2 caval thrombi and 1 patient required synthetic patch cavoplasty. Mean operative time was 292 minutes (range 180 to 411) with a mean blood loss of 399 cc (range 25 to 2,000). There were no conversions to open surgery or aborted procedures and there were 3 transfusions of 1 to 3 units. All but 2 patients ambulated by postoperative day 1 and mean hospital stay was 3.2 days (range 1 to 7). Lymphadenectomy in 24 patients yielded a mean of 11 nodes and 8 patients had node positive disease. There were 7 patients who experienced distant recurrence at a mean followup of 15.4 months, including 4 who had node positive disease on postoperative pathological examination.
  
  
  
  Robotic nephrectomy in the setting of inferior vena cava tumor thrombus is feasible and was performed safely in selected patients. Despite the complex and critical nature of these procedures, our series demonstrates favorable outcomes and reproducibility with adequate robotic experience.
authors.affiliation: OhioHealth Dublin Methodist Hospital, Dublin, Ohio. Electronic address: ronney.abaza@ohiohealth.com.
authors.forename: Ronney
authors.initials: R
authors.lastname: Abaza
authors.affiliation: Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Shabsigh
authors.affiliation: Mayo Clinic Arizona, Phoenix, Arizona.
authors.forename: Erik
authors.initials: E
authors.lastname: Castle
authors.affiliation: Johns Hopkins Medical Center, Baltimore, Maryland.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Allaf
authors.affiliation: Weill Cornell Medical College, New York, New York.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Henry Ford Health System, Detroit, Michigan.
authors.forename: Craig
authors.initials: C
authors.lastname: Rogers
authors.affiliation: Henry Ford Health System, Detroit, Michigan.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: University of Southern California Medical Center, Los Angeles, California.
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
authors.affiliation: Indiana University Medical Center, Indianapolis, Indiana.
authors.forename: Chandru P
authors.initials: CP
authors.lastname: Sundaram
authors.affiliation: Temple University Medical Center, Philadelphia, Pennsylvania.
authors.forename: Daniel
authors.initials: D
authors.lastname: Eun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D014682:Vena Cava, Inferior / Q000473:pathology*; D020246:Venous Thrombosis / Q000209:etiology / Q000601:surgery
keywords: carcinoma; inferior; laparoscopy; nephrectomy; renal cell; robotics; vena cava