V10-09 CHALLENGING RENAL CELL CARCINOMA CASES WITH INFERIOR VENA CAVA INVOLVEMENT: FROM EXTIRPATION TO CAVAL REPLACEMENT

Abstract

You have accessJournal of UrologyAdrenal Surgery & Kidney Cancer II (Advanced Kidney Cancer & Vascular Reconstruction) (V10)1 Apr 2020V10-09 CHALLENGING RENAL CELL CARCINOMA CASES WITH INFERIOR VENA CAVA INVOLVEMENT: FROM EXTIRPATION TO CAVAL REPLACEMENT Kathryn Scott* and Gennady Bratslavsky Kathryn Scott*Kathryn Scott* More articles by this author and Gennady BratslavskyGennady Bratslavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000935.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this video presentation we describe three complex cases of renal cell carcinoma (RCC) with inferior vena cava (IVC) involvement managed robotically by a urologic oncologist. METHODS: Robotic assistance was used to treat three different cases of RCC with IVC involvement. In all 3 cases radical nephrectomy was performed and combined with IVC thrombectomy or resection with either IVC repair or replacement. The first case demonstrates a large right renal mass with an 11cm level III IVC thrombus. This was excised using robotic assistance and the IVC was primarily repaired. The second case demonstrates management of a large right renal mass invading into the liver and abdominal side wall and having an IVC thrombus. Using robotic assistance we performed partial hepatectomy (segment VI), IVC thrombectomy, radical nephrectomy, and abdominal wall resection in the order listed above. The final case demonstrates management of recurrent RCC after right partial nephrectomy 5 years prior to diagnosis with direct invasion of the IVC. A nephrectomy with IVC resection was performed. In this case the IVC is replaced with a vascular graft. RESULTS: All the presented cases were completed robotically by a single urologic oncologist. All patients were discharged to home 36-48 hours postoperatively. There were no perioperative complications. All patients are alive and have no local recurrence as of follow-up at 5, 1.5, and 1.5 years later, respectively. This video focuses on important technical aspects of each case. Important teaching points included stress the importance of mobilization of the caudate lobe via ligation of short hepatic veins, allowing IVC to back bleed during completion of the closure to avoid catastrophic events of clot or air embolus, management of the liver invasion, and IVC closure/replacement techniques. Additional technical caveats are highlighted during the narrative of this video presentation. CONCLUSIONS: Robotic assistance may expand the armamentarium for complex cases in urologic oncology allowing for benefits of a minimally invasive approach and minimizing hospital stay. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e933-e933 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kathryn Scott* More articles by this author Gennady Bratslavsky More articles by this author Expand All Advertisement PDF downloadLoading ...