Zhuo Liu1, Peng Hong1, Guodong Zhu1, Li Zhang2, Xun Zhao1, Shiying Tang1, Feilong Yang1, Xiaojun Tian1, Guoliang Wang1, Shudong Zhang1, Hongxian Zhang1, Yi Huang1, Chunxia Liu3, Cheng Liu4, Lulin Ma5. 1. Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China. 2. Department of Ultrasound Diagnosis, Peking University Third Hospital, Beijing, China. 3. Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China. frombmu@163.com. 4. Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China. chengliu@bjmu.edu.cn. 5. Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China. malulinpku@163.com.
Abstract
PURPOSE: To explore the safety and effectiveness of delayed occlusion of the proximal inferior vena cava (DOPI) technique in retroperitoneal laparoscopic radical nephrectomy (LRN) and thrombectomy for renal tumor with level II-III venous tumor thrombus (VTT). MATERIALS AND METHODS: From August 2016 to October 2018, a total of 145 patients with renal tumor and VTT were admitted to our centre. Seventy-five patients underwent laparoscopic surgery, and 70 patients underwent open surgery. Among these patients, 17 patients underwent retroperitoneal LRN and thrombectomy with the DOPI technique. Clinical data were collected retrospectively, and a descriptive statistical analysis was conducted. RESULTS: All the patients successfully underwent retroperitoneal laparoscopic surgery. The mean operation time was 345.9 ± 182.9 min, the mean estimated blood loss was 466.7 ± 245.5 ml. Postoperative complications occurred in three patients, including two patients of Clavien grading system level IVa and one patient of level II. There were no complications related to carbon dioxide pneumoperitoneum, such as gas embolism, acidosis, and subcutaneous emphysema. During 21 months of median follow-up time, no local recurrence was found, and distant metastasis occurred in four patients. Cancer-specific death occurred in two patients. CONCLUSIONS: The DOPI technique is safe and feasible in the treatment of renal tumor and level II-III VTT. With the DOPI technique, the procedures of dissociating and exposing proximal inferior vena cava are simplified.
PURPOSE: To explore the safety and effectiveness of delayed occlusion of the proximal inferior vena cava (DOPI) technique in retroperitoneal laparoscopic radical nephrectomy (LRN) and thrombectomy for renal tumor with level II-III venous tumor thrombus (VTT). MATERIALS AND METHODS: From August 2016 to October 2018, a total of 145 patients with renal tumor and VTT were admitted to our centre. Seventy-five patients underwent laparoscopic surgery, and 70 patients underwent open surgery. Among these patients, 17 patients underwent retroperitoneal LRN and thrombectomy with the DOPI technique. Clinical data were collected retrospectively, and a descriptive statistical analysis was conducted. RESULTS: All the patients successfully underwent retroperitoneal laparoscopic surgery. The mean operation time was 345.9 ± 182.9 min, the mean estimated blood loss was 466.7 ± 245.5 ml. Postoperative complications occurred in three patients, including two patients of Clavien grading system level IVa and one patient of level II. There were no complications related to carbon dioxidepneumoperitoneum, such as gas embolism, acidosis, and subcutaneous emphysema. During 21 months of median follow-up time, no local recurrence was found, and distant metastasis occurred in four patients. Cancer-specific death occurred in two patients. CONCLUSIONS: The DOPI technique is safe and feasible in the treatment of renal tumor and level II-III VTT. With the DOPI technique, the procedures of dissociating and exposing proximal inferior vena cava are simplified.
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