Kidney cancer is not always confined to the kidney. In advanced cases, this cancer invades the body’s biggest vein, the inferior vena cava, which carries blood out of the kidneys back to the heart. Via the IVC, cancer may infiltrate the liver and heart.
The Mays Cancer Center at UT Health San Antonio is one of the high-volume centers in the U.S. with surgical expertise in treating this serious problem.
In a study featured on the cover of the Journal of Urology, researchers from the Mays Cancer Center and the Department of Urology at UT Health San Antonio show that robotic IVC thrombectomy — the 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, which is performed at UT Health San Antonio’s clinical partner, University Hospital.
Harshit Garg, MD, urologic oncology fellow in the Department of Urology, is first author of the study, and Dharam Kaushik, MD, urologic oncology fellowship program director, is the senior author.
The open surgery requires an incision that begins 2 inches below the ribcage and extends downward on both sides of the ribcage.
“It looks like an inverted V,” Kaushik said. 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.
“Open surgery has an excellent success rate, and most cases are performed in this manner,” Kaushik said. “But now, with the robotic approach, we can achieve similar results with smaller incisions. Therefore, we need to study the implications of utilizing this newer approach.”
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. Kaushik and his team collaborated with Memorial Sloan Kettering Cancer Center, New York; Cedars-Sinai Medical Center, Los Angeles; and the University of Washington, Seattle, to perform this study.
The results are encouraging, finding:
- Fewer blood transfusions: 18% of robotic patients required transfusions compared to 64% of open patients.
- Fewer complications: 14.5% of robotic patients experienced complications such as bleeding compared to 36.7% of open thrombectomy patients.
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, Kaushik said.
This is the largest study to analyze the outcomes of robotic versus open IVC thrombectomy, Kaushik said. While open surgery remains the gold standard for surgery, the study shows the robotic variation could be a good option for certain patients, he added.
“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,” Kaushik said.