AUA 2018: Comparison of Robotic and Open Techniques in Patients Undergoing Radical Nephrectomy and Level II/III Inferior Vena Cava Thrombectomy

San Francisco, CA ( The boundaries of robotic surgery continue to be advanced. Recent reports have begun to explore the role of robotic surgery for the management of patients with renal cell carcinoma and IVC thrombus.  Inderbir S. Gill, MD, from USC presented on the USC experience in the open vs. robotic surgery debate at the 2017 Winter meeting of the Society of Urologic Oncology. Similarly,  the groups from NYC and Philadelphia report their experience with robotic vs. open surgery for patients with Level II/III tumor thrombus.

Importantly, as Gill mentioned in the SUO debate, these are still well-selected patients. In this abstract, the authors present their multi-institutional database of 21 patients that underwent robotic or open radical nephrectomy (RN) with level II or III IVC thrombus. 

Of these patients, 11 (52.4%) patients underwent a robotic approach, whereas 10 (48.6%) underwent open RN. Baseline clinical and pathologic characteristics were similar between the two groups – except for Charlson Comorbidity Index (mean score 4 for robotic arm, mean score 0 for open arm). Importantly, patients had similar cTNM staging, tumor size, BMI, histology. 

In terms of outcomes, the only differences in outcome measures were significantly higher blood loss for the open vs. robotic approach (600 vs. 87.5 mL, p=0.009) and longer length of stay for the open approach (5 vs. 2 days, p=0.005). No significant differences in operative time (240.0 vs. 235.0 minutes; p=0.496), transfusion rates (n=5 v. n=2; p=0.349), post-operative complication rates (n=2 vs. n=2; p>0.999), or recurrence free-survival at median 5.6 months (Median 23 months vs. not reached; p=0.825) were found between the open and robotic approach.

Some questions that were unanswered:
1. They don’t specifically comment on robotic converted to open. How many of the open cases were started robotically?
2. What was their selection criteria for open or robotic? Was it surgeon dependent? Was it randomized?

These are important factors that need to be addressed, but this data adds to the growing literature regarding the safety of robotic tumor thrombectomy.

Presented by: Alp Tuna Beksac, MD, Icahn School of Medicine at Mount Sinai
Co-Authors: David Paulucci, John P. Sfakianos, Reza Mehrazin, New York, NY, Ronney Abaza, Dublin, OH, Daniel Eun, Philadelphia, PA, Ketan Badani, New York, NY

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, @tchandra_uromd at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA