Seong Il Seo

• Renal Cell Carcinoma
  Chi-Ping HuangTaiwan Moderator

  Duc Minh PhamVietnam Moderator
• RCC and IVC Thrombectomy
  Siros JitpraphaiThailand Speaker RCC and IVC ThrombectomyRCC and IVC thrombus Siros Jitpraphai Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THAILAND Abstract Renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus represents a complex surgical challenge, with an incidence of venous involvement in 4-10% of cases. This case report demonstrates the successful surgical management of a 58-year-old female patient with a large left-sided renal mass and IVC thrombus. The patient presented with gross hematuria and was diagnosed with a 10 cm clear cell renal cell carcinoma (Fuhrman nuclear grade 3) extending into the renal vein and IVC. Recognizing the complexity of the case, a multidisciplinary approach was employed, involving urological and hepatobiliary surgical teams. The comprehensive treatment strategy included an open radical nephrectomy with IVC thrombectomy. The surgical technique was meticulously planned and executed, with several key considerations. Preoperative imaging was crucial in determining the exact level of thrombus, allowing for precise surgical planning. The procedure emphasized careful vascular control and en-bloc tumor removal, with intraoperative ultrasound used to ensure accurate thrombus localization. Surgical teams worked collaboratively to minimize potential complications and maximize surgical success. Operatively, the procedure was substantial, with an estimated blood loss of 900 mL and a total operative time of 5 hours. The patient required two days of postoperative intensive care and was discharged from the hospital seven days after the surgery. Pathological examination confirmed the diagnosis of clear cell renal cell carcinoma, with no lymph node metastasis detected and positive tumor thrombus. Importantly, surgical margins were found to be free of tumor. Follow-up evaluations have been encouraging, with no signs of tumor recurrence observed during regular intervals. This case illustrates the critical importance of a systematic surgical approach, precise technical execution, and comprehensive multidisciplinary management in successfully treating RCC with IVC thrombus. It provides valuable insights into the complex surgical management of this challenging condition, potentially offering guidance for similar cases in the future. Keyword: RCC (Renal Cell Carcinoma), IVC Thrombus, Thrombectomy, Surgical Technique, Multidisciplinary Management Highlight: RCC with IVC thrombus is a complex surgical challenge affecting 4-10% of cases. Successful management requires meticulous preoperative imaging, multidisciplinary team approach, and precise surgical technique. With careful planning and execution, 45-70% of patients can be cured through radical nephrectomy and IVC thrombectomy. Robotic Partial Nephrectomy in Complex and Difficult Tumor Location
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• Robotic Partial Nephrectomy: Making Things Easier
  Brian Sze-ho HoHong Kong, China Speaker Robotic Partial Nephrectomy: Making Things Easier
• How to Make the Best Decision with Systemic Therapy Sequence in Respective of Genetic Analysis
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• Comparison of Remal Function between Radiofrequency Ablation versus Robot Assisted Laparoscopic Patial Nephrectomy for Small Renal Mass in Elderly Patients
  Seong Il SeoKorea (Republic of) Speaker Comparison of Remal Function between Radiofrequency Ablation versus Robot Assisted Laparoscopic Patial Nephrectomy for Small Renal Mass in Elderly PatientsComparison of renal function between radiofrequency ablation versus robot assisted laparoscopic partial nephrectomy for small renal mass in elderly patients Jiwoong Yu, Seongil Seo Sungkyunkwan University, Samsung Medical Center The incidence of small renal masses (SRMs) in patients ≥75 years has increased up to 30-fold [J Urol 2014]. In this age group, treatment should balance cancer control and renal function preservation. Robot-assisted partial nephrectomy (RAPN) and radiofrequency ablation (RFA) are two main options. RAPN offers excellent cancer control but requires general anesthesia and ischemia, which may pose risks in older patients. RFA is less invasive, avoids vascular clamping, and is often preferred for high-risk patients, as supported by EAU and AUA guidelines. RFA generally preserves renal function better [Front Oncol 2022], though outcomes vary by technique. At our center, RFA under general anesthesia with wide safety margins may compromise parenchymal preservation. While both approaches show favorable cancer control, RFA has a slightly higher recurrence rate. Pantelidou et al. reported 6 recurrences in 63 RFA cases vs. 1 in 63 RAPN cases [Cardiovasc Intervent Radiol 2016], and Park et al. reported 2-year recurrence-free survival (RFS) of 95.2% in RFA vs. 100% in RAPN [Eur Radiol 2018]. NCCN guidelines note that RFA may require repeat treatment to match surgical outcomes. Our institutional matched analysis (63 RAPN vs. 63 RFA) showed RFS of 100% vs. 95.2% (p = 0.029), and immediate eGFR preservation of 91.7% vs. 86.8% [Eur Radiol 2018;28:2979–2985]. A subsequent analysis of older patients presented at AUA 2024 included 137 patients aged ≥75, the rate of ≥25% eGFR decline at one year was 28.6% for RFA vs. 2.0% for RAPN (HR 11.3, p = 0.002), with 4 recurrences in RFA and none in RAPN. In conclusion, both RFA and RAPN are viable options for elderly patients with small renal masses. RFA is less invasive but may carry a slightly higher risk of recurrence and, depending on institutional technique, some degree of renal function loss. Treatment should be individualized based on tumor anatomy, patient condition, and institutional expertise.
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