Sage Journals: Discover world-class research

Abstract

Purpose:

Robot-assisted nephrectomy and inferior vena cava (IVC) thrombectomy are technically demanding and high-risk procedures. The role of multidisciplinary team (MDT) management in robotic surgeries has not been reported previously. This study aimed to evaluate the safety and feasibility of MDT management in robot-assisted nephrectomy and IVC thrombectomy.

Patients and Methods:

We retrospectively analyzed 209 patients who underwent robot-assisted nephrectomy and IVC thrombectomy for renal tumor with venous tumor thrombus (Mayo levels I–IV) in our center between June 2013 and December 2023. Since July 2018, a proactive, comprehensive, and full-process MDT management framework has been implemented perioperatively. Patients were divided into MDT management (n = 142) and non-MDT management (n = 67) groups, with propensity score matching (1:1) resulting in 67 patients in each group. Multivariable regression, survival analyses, and interrupted time series analysis were conducted to assess perioperative outcomes and survival.

Results:

All procedures were completed without conversion. MDT management significantly improved perioperative outcomes compared with the non-MDT group. Specifically, MDT reduced estimated blood loss (p = 0.045), intraoperative blood transfusion (p = 0.009), blood transfusion volume (p = 0.005), postoperative intensive care unit stay (p = 0.002), and postoperative hospital stay (p < 0.001). Multivariable regression confirmed that these improvements were independent of other factors. MDT management was associated with a significant improvement in overall survival (hazard ratio [HR] = 0.27, p = 0.023) and a potential benefit in progression-free survival (HR = 0.40, p = 0.065), as indicated by survival analysis.

Conclusions:

MDT management in robot-assisted nephrectomy and IVC thrombectomy improves perioperative safety and enhances survival outcomes. This study highlights the critical role of the standardized MDT framework we proposed in optimizing high-risk robotic procedures.

Keywords

kidney neoplasms multidisciplinary team robotic surgical procedures nephrectomy thrombectomy

Get full access to this article

View all access options for this article.

References

Chen

, Yang

, Ge

, et al. Outcomes of renal cell carcinoma with associated venous tumor thrombus: Experience from a large cohort and short time span in a single center. BMC Cancer, 2021; 21(1):766; doi: 10.1186/s12885-021-08508-x

Ljungberg

, Albiges

, Abu-Ghanem

, et al. European association of urology guidelines on renal cell carcinoma: The 2022 update. Eur Urol, 2022; 82(4):399–410; doi: 10.1016/j.eururo.2022.03.006

Ciancio

, Manoharan

, Katkoori

, et al. Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: Single-center experience. Eur Urol, 2010; 57(4):667–672; doi: 10.1016/j.eururo.2009.06.009

Gayed

, Youssef

, Darwish

, et al. Multi-disciplinary surgical approach to the management of patients with renal cell carcinoma with venous tumor thrombus: 15 year experience and lessons learned. BMC Urol, 2016; 16(1):43; doi: 10.1186/s12894-016-0157-3

Master

, Ethun

, Kooby

, et al. The value of a cross-discipline team-based approach for resection of renal cell carcinoma with IVC tumor thrombus: A report of a large, contemporary, single-institution experience. J Surg Oncol, 2018; 118(8):1219–1226; doi: 10.1002/jso.25271

, Wang

, Wu

, et al. Role of a multidisciplinary team (MDT) in the diagnosis, treatment, and outcomes of inflammatory bowel disease: A single Chinese center’s experience. Biosci Trends, 2021; 15(3):171–179; doi: 10.5582/bst.2021.01174

Zhang

, Yu

, Wei

, et al. The effect of multidisciplinary team discussion intervention on the prognosis of advanced colorectal cancer. J Cancer, 2021; 12(11):3307–3314; doi: 10.7150/jca.56171

Rosander

, Holm

, Sjövall

, et al. Preoperative multidisciplinary team assessment is associated with improved survival in patients with locally advanced colon cancer; a nationwide cohort study in 3157 patients. Eur J Surg Oncol, 2021; 47(9):2398–2404; doi: 10.1016/j.ejso.2021.05.008

Abaza

. Initial series of robotic radical nephrectomy with vena caval tumor thrombectomy. Eur Urol, 2011; 59(4):652–656; doi: 10.1016/j.eururo.2010.08.038

10.

Gill

, Metcalfe

, Abreu

, et al. Robotic level III inferior vena cava tumor thrombectomy: Initial series. J Urol, 2015; 194(4):929–938; doi: 10.1016/j.juro.2015.03.119

11.

Wang

, Huang

, Liu

, et al. Robot-assisted level III-IV inferior vena cava thrombectomy: Initial series with step-by-step procedures and 1-yr outcomes. Eur Urol, 2020; 78(1):77–86; doi: 10.1016/j.eururo.2019.04.019

12.

Shah

, Wang

, Shah

, et al. A narrative review on robotic surgery as treatment for renal cell carcinoma with inferior vena cava thrombus. J Clin Med, 2024; 13(5):1308; doi: 10.3390/jcm13051308

13.

, Peng

, Liang

, et al. Neoadjuvant toripalimab plus axitinib for clear cell renal cell carcinoma with inferior vena cava tumor thrombus: NEOTAX, a phase 2 study. Signal Transduct Target Ther, 2024; 9(1):264; doi: 10.1038/s41392-024-01990-2

14.

Huang

, Liu

, Peng

, et al. Single-center experience of robot-assisted nephrectomy and venous tumor thrombectomy: Indications, surgical strategies, and long-term outcomes. J Endourol, 2025; 39(11):1125–1133; doi: 10.1177/08927790251363235

15.

Fan

, Li

, Zhang

, et al. Robotic radical nephrectomy and thrombectomy for left renal cell carcinoma with renal vein tumor thrombus: Superior mesenteric artery as an important strategic dividing landmark. J Endourol, 2019; 33(7):557–563; doi: 10.1089/end.2019.0159

16.

Wang

, Li

, Ma

, et al. Robot-assisted laparoscopic inferior vena cava thrombectomy: Different sides require different techniques. Eur Urol, 2016; 69(6):1112–1119; doi: 10.1016/j.eururo.2015.12.001

17.

Shi

, Huang

, Liu

, et al. Robot-assisted cavectomy versus thrombectomy for level II inferior vena cava thrombus: Decision-making scheme and multi-institutional analysis. Eur Urol, 2020; 78(4):592–602; doi: 10.1016/j.eururo.2020.03.020

18.

Wang

, Li

, Huang

, et al. Robot-assisted retrohepatic inferior vena cava thrombectomy: First or second porta hepatis as an important boundary landmark. Eur Urol, 2018; 74(4):512–520; doi: 10.1016/j.eururo.2017.11.017

19.

Shen

, Du

, Huang

, et al. A modified sequential vascular control strategy in robot-assisted level III-IV inferior vena cava thrombectomy: Initial series mimicking the open ‘milking’ technique principle. BJU Int, 2020; 126(4):447–456; doi: 10.1111/bju.15094

20.

Huang

, Zhao

, Chen

, et al. Robotic level IV inferior vena cava thrombectomy using an intrapericardial control technique: Is it safe without cardiopulmonary bypass? J Urol, 2023; 209(1):99–110; doi: 10.1097/ju.0000000000002952

21.

Shuch

, Larochelle

, Onyia

, et al. Intraoperative thrombus embolization during nephrectomy and tumor thrombectomy: Critical analysis of the University of California-Los Angeles experience. J Urol, 2009; 181(2):492–498; discussion 498-9; doi: 10.1016/j.juro.2008.10.036

22.

Agochukwu

, Shuch

. Clinical management of renal cell carcinoma with venous tumor thrombus. World J Urol, 2014; 32(3):581–589; doi: 10.1007/s00345-014-1276-7

23.

Blute

, Leibovich

, Lohse

, et al. The mayo clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int, 2004; 94(1):33–41; doi: 10.1111/j.1464-410X.2004.04897.x

24.

Dason

, Mohebali

, Blute

, et al. Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. Urol Clin North Am, 2023; 50(2):261–284; doi: 10.1016/j.ucl.2023.01.007

25.

Scott

. Multidisciplinary team approach in cancer care: A review of the latest advancements. Oncology, 2021; 2–13.

26.

Huang

, Peng

, Du

, et al. Virtual-reality robotic-assisted inferior vena cava thrombectomy using virtual vascular endoscopy to identify inferior vena cava invasion. Asian J Urol, 2025; 12(3):375–384; doi: 10.1016/j.ajur.2024.08.004

27.

Shen

, Wang

, et al. Cumulative sum analysis of the operator learning curve for robot-assisted mayo clinic level I-IV inferior vena cava thrombectomy associated with renal carcinoma: A study of 120 cases at a single center. Med Sci Monit, 2020; 26:e922987; doi: 10.12659/msm.922987

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.03 MB

0.00 MB

0.01 MB

Multidisciplinary Team Management Improves Safety and Survival in Robot-Assisted Nephrectomy and Inferior Vena Cava Thrombectomy: A Propensity Score-Matched Study

Abstract

Purpose:

Patients and Methods:

Results:

Conclusions:

Keywords

Get full access to this article

References

Supplementary Material