Robotic Retrohepatic Inferior Vena Cava Thrombectomy with the 3C Technique: A Stepwise and Reproducible Approach for T3c Tumor Thrombus.

Authors

Cheng Peng, Jialong Song, Kan Liu, Zhuo Jia, Yibo Chen, Qilong Jiao, Zhi Li, Changwei Shi, Chenzhi Zhao, Liangyou Gu, Junnan Xu, Yinzhe Xu, Lukas Lusuardi, Xu Zhang, Xin Ma, Qingbo Huang

Published in

European urology open science. Volume 91. Pages 1-9. Epub Jul 16, 2026.

Abstract

Robot-assisted retrohepatic inferior vena cava (IVC) thrombectomy (RA-IVCT) is a high-risk procedure. We previously proposed caudate lobectomy for complex retrohepatic tumor thrombus, demonstrating safety and feasibility. Nonetheless, RA-IVCT for patients with tumor thrombus around the hepatic vein and involving the IVC wall (T3c disease) represents the most challenging scenario with a high complication rate.
To develop the stepwise and reproducible 3C technique, and to evaluate its feasibility and safety.
We conducted a comparative study of 12 patients who underwent RA-IVCT using the 3C technique, with 12 patients as controls who underwent the previously reported RA-IVCT technique.
The 3C technique is indicated for thrombus around the hepatic vein, suspected IVC wall invasion, and well-developed collateral circulation. First, suprahepatic IVC control was established. Second, a caudate lobectomy was performed via parenchymal transection between the paracaval portion and the Spiegel's lobe. Third, tumor-bearing IVC cavectomy was performed through caudal-to-cephalic stapling.
Baseline data, perioperative outcomes, and short-term survival rates were analyzed.
All 3C procedures were completed robotically, whereas four controls required open conversion. The 3C group had a shorter liver mobilization time (126 min vs 182 min, p = 0.015), less blood loss (850 ml vs 2450 ml, p = 0.002), lower transfusion volume (p = 0.005), and fewer complications (p = 0.031). Organ function and survival rates were comparable. Limitations included small sample size, single-center experience, and nonrandomized design.
The 3C technique is a safe, stepwise, and reproducible robotic approach for retrohepatic tumor thrombus with IVC wall invasion.

PMID:
42502705
Bibliographic data and abstract were imported from PubMed on 26 Jul 2026.

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