Robot-assisted versus open surgery for radical nephrectomy with level 1-2 vena cava tumor thrombectomy : a French monocenter experience (UroCCR study #73).

Abstract

BACKGROUND To assess the feasibility of Robot-assisted Radical nephrectomy with Inferior Vena Cava Thrombectomy (RRVCT) and compare peri operative and oncological outcomes of this approach to open surgery for renal tumors with Level 1-2 Inferior Vena Cava (IVC) Thrombus. METHODS We performed a retrospective analysis of patients surgically treated for renal cancer with IVC level 1-2 thrombus in the Urology department of Bordeaux University Hospital between December 2015 and December 2019. Patients were stratified by surgical approach in two groups : open vs robotic procedures. Pre, per and post-operative data were collected within the framework of the UroCCR project (NCT03293563). Univariate and multivariate analysis using regression models were performed. RESULTS A total of 40 patients underwent Radical Nephrectomy (RN) with IVC tumor thrombus. Open and robotic surgery represented respectively 30 and 10 cases. The two groups were comparable regarding pre-operative tumor and patient characteristics. Robotic procedures were associated with lower Estimated Blood Loss (EBL) (500 vs. 1250mL, p = 0.02), shorter Intensive Care Unit stay (2 vs. 4 days, p = 0.03) and decrease of global Length Of Stay (LOS) (7 vs. 10 days, p < 0.01). Operative Time (OT) was significantly longer in the robotic group (350.5 vs. 208 min, p < 0.01). No difference were observed between the two approaches regarding complications and oncological outcomes. CONCLUSIONS Robotic approach induced lower bleeding and shorter LOS but required longer OT. This technique is feasible and safe for selected cases and experimented surgical team. Complications rate and oncological outcomes are not different compared to standard open procedures.