V04-12 Level 2 Vena Cava Thrombectomy and Robot Assisted Radical Nephrectomy Following Immunotherapy

You have accessJournal of UrologyAdrenal/Renal Oncology I (V04)1 May 2024V04-12 LEVEL 2 VENA CAVA THROMBECTOMY AND ROBOT ASSISTED RADICAL NEPHRECTOMY FOLLOWING IMMUNOTHERAPY Gaëlle Margue, Fabien Moinard-Butot, Jonathan Thouvenin, Baptiste Sionneau, Abderrahmane Khaddad, Marine Gross-Goupil, Alain Ravaud, Franck Bladou, Grégoire Robert, Philippe Barthelemy, Strasbourg France, and Jean-Christophe Bernhard Gaëlle MargueGaëlle Margue , Fabien Moinard-ButotFabien Moinard-Butot , Jonathan ThouveninJonathan Thouvenin , Baptiste SionneauBaptiste Sionneau , Abderrahmane KhaddadAbderrahmane Khaddad , Marine Gross-GoupilMarine Gross-Goupil , Alain RavaudAlain Ravaud , Franck BladouFranck Bladou , Grégoire RobertGrégoire Robert , Philippe BarthelemyPhilippe Barthelemy , Strasbourg FranceStrasbourg France , and Jean-Christophe BernhardJean-Christophe Bernhard View All Author Informationhttps://doi.org/10.1097/01.JU.0001009444.59519.d3.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim was to present a robot assisted level 2 vena cava thrombectomy and cytoreductive nephrectomy with retroperitoneal lymph node dissection in a patient previously treated with immunotherapy. METHODS: The surgery was performed using the Da-Vinci Xi surgical robot (Intuitive surgical). We used 3 operative arms, a 30° optic and 2 trocars (5 and 12 mm) for the assistant. Thrombus extension was assessed using an intraoperative ultrasound (Hitachi). RESULTS: Our patient was a 69-year-old man diagnosed with poor prognosis clear cell renal cell carcinoma (ccRCC) with synchronous lymph node invasion and pulmonary metastases in a context of anemia. He was initially treated with combined immunotherapy (NIVOLUMAB+IPILIMUMAB) followed by NIVOLUMAB every month for seven months. A complete response to immunotherapy was observed on metastatic sites and a partial response on the thrombus, mainly a diameter reduction without level's lowering. Surgical management with robot assisted radical nephrectomy, vena cava thrombectomy and retroperitoneal lymph node dissection was decided. After colonic detachment, anterior and lateral sides of the vena cava were dissected, and ultrasound was performed to visualize thrombus extension. Dissection was continued at the posterior face of the vena cava and lateral side of the aorta. Right renal artery was clipped and sectioned. Vascular clamps were placed on the left renal vein, subrenal vena cava and subhepatic vena cava to allow single block cavotomy and thrombectomy. Abundant irrigation of the vena cava was performed before complete closure. Finally, radical nephrectomy and retroperitoneal lymph node dissection were completed after unclamping. The length of surgery was three hours and a half with 15 minutes of vena cava clamping and an estimated blood loss of 200 mL. The pathological report confirmed an ISUP 3, ccRCC of 9 cm with carcinomatous thrombus and significant fibrous and necrotic remodeling. A french retrospective multicentric study included 44 metastatic patients with venous thrombus and treated with immunotherapy. It showed a response rate of about 36% but mostly on diameter without change in thrombus level which is consistant with our case. CONCLUSIONS: Surgical difficulties following immunotherapy are debated. In this case, the surgery was feasible with no more difficulties than without immunotherapy. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e199 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Gaëlle Margue More articles by this author Fabien Moinard-Butot More articles by this author Jonathan Thouvenin More articles by this author Baptiste Sionneau More articles by this author Abderrahmane Khaddad More articles by this author Marine Gross-Goupil More articles by this author Alain Ravaud More articles by this author Franck Bladou More articles by this author Grégoire Robert More articles by this author Philippe Barthelemy More articles by this author Strasbourg France More articles by this author Jean-Christophe Bernhard More articles by this author Expand All Advertisement PDF downloadLoading ...