Robotic Kidney Cancer Surgery Offers Smaller Incisions, Fewer Blood Transfusions and Complications

Kidney cancer is not always confined to the kidney. In advanced cases, this cancer invades the body’s biggest vein, the inferior vena cava (IVC), which carries blood out of the kidneys back to the heart. Via the IVC, cancer may infiltrate the liver and heart. Now, a new study has shown that robotic IVC thrombectomy (removal of cancer from the inferior vena cava) is not inferior to standard open IVC thrombectomy and is a highly safe and effective alternative approach. The affected kidney is removed along with the tumor during surgery.

The open surgery requires an incision that begins two inches below the ribcage and extends downward on both sides of the ribcage. Next, organs that surround the IVC, such as the liver, are mobilized, and the IVC is clamped above and below the cancer. In this way, surgeons gain control of the inferior vena cava for cancer resection. These large, technically challenging surgeries last eight to 10 hours and involve a multidisciplinary team of vascular surgeons, cardiac surgeons, transplant surgeons and urologic oncology surgeons.

Image: Robotic kidney cancer surgery showed desirable outcomes in study (Photo courtesy of UT Health San Antonio)

The study was conducted by researchers from the Mays Cancer Center and Department of Urology at The University of Texas Health Science Center at San Antonio (San Antonio, TX, USA), which is one of the high-volume centers in the U.S. with surgical expertise in treating this serious problem. The study is a systematic review and meta-analysis of data from 28 studies that enrolled 1,375 patients at different medical centers. Of these patients, 439 had robotic IVC thrombectomy and 936 had open surgery.

The study found that 18% of robotic patients required transfusions compared to 64% of open patients. Additionally, 5% of robotic patients experienced complications such as bleeding compared to 36.7% of open thrombectomy patients. The results are encouraging and indicate further study of robotic IVC thrombectomy is warranted.

“This study is the largest meta-analysis analyzing the outcomes of robotic versus open IVC thrombectomy,” said Dharam Kaushik, MD, urologic oncology fellowship program director, who is the senior author of the study. “In more than 1,300 patients, we found that overall complications were lower with the robotic approach and the blood transfusion rate was lower with this approach.

“That tells us there is more room for us to grow and refine this robotic procedure and to offer it to patients who are optimal candidates for it,” added Kaushik. “Optimal candidacy for a robotic surgery should be based on a surgeon’s robotic expertise, the extent and burden of the tumor, and the patient’s comorbid conditions. The open surgical approach remains the gold standard for achieving excellent surgical control.”