inovmedИнновационная медицина КубаниInnovative Medicine of Kuban2541-9897Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 110.35401/2541-9897-2026-11-1-116-122inovmed-1453Research ArticleОБЗОРЫREVIEWSРобот-ассистированная радикальная нефрэктомия с тромбэктомией из нижней полой веныRobot-Assisted Radical Nephrectomy with Inferior Vena Cava Thrombectomyhttps://orcid.org/0000-0001-8335-2578МедведевВ. Л.MedvedevV. L.

Медведев Владимир Леонидович - д. м. н., профессор, заведующий кафедрой урологии, КубГМУ; заместитель главного врача по урологии, руководитель краевого уронефрологического центра, НИИ – ККБ № 1 им. проф. С.В. Очаповского.

Краснодар

Vladimir L. Medvedev - Dr. Sci. (Med.), Professor, Head of the Urology Department, Kuban State Medical University; Deputy Chief Physician for Urology, Head of the Regional Uronephrolgy Center, Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1.

Krasnodar

https://orcid.org/0009-0004-0858-3316МануйловВ. Н.ManuilovV. N.

Мануйлов Валерий Наириевич - ассистент кафедры урологии, КубГМУ; врач-уролог, НИИ – ККБ № 1 им. проф. С.В. Очаповского.

350063, Краснодар, ул. Митрофана Седина, 4

Valeriy N. Manuilov - Assistant Professor, Department of Urology, Kuban State Medical University; Urologist, Urology Unit No. 2, Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1.

4 Mitrofana Sedina St., Krasnodar, 350063

manuilovvalerii27@yandex.ruhttps://orcid.org/0009-0002-1592-4954СтреляевА. И.StrelyaevA. I.

Стреляев Александр Иванович - заведующий отделением онкоурологии, НИИ – ККБ № 1 им. проф. С.В. Очаповского.

Краснодар

Alexander I. Strelyaev - Head of the Oncourology Department, Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1.

Krasnodar

https://orcid.org/0009-0007-3291-1342ФоменкоЮ. A.FomenkoYu. A.

Фоменко Юлиан Ангелович - аспирант кафедры урологии, КубГМУ; врач-уролог урологического отделения № 2, НИИ – ККБ № 1 им. проф. С.В. Очаповского.

Краснодар

Yulian A. Fomenko - Postgraduate Student, Urology Department, Kuban State Medical University; Urologist, Urology Unit No. 2, Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1.

Krasnodar

https://orcid.org/0000-0001-6657-1496ЛепетуновС. Н.LepetunovS. N.

Лепетунов Сергей Николаевич - к. м. н., ассистент кафедры урологии, КубГМУ; врач-уролог, НИИ – ККБ № 1 им. проф. С.В. Очаповского.

Краснодар

Sergey N. Lepetunov - Cand. Sci. (Med.), Assistant Professor, Department of Urology, Kuban State Medical University; Urologist, Urology Unit No. 2, Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1.

Krasnodar

Кубанский государственный медицинский университет; Научно-исследовательский институт – Краевая клиническая больница № 1 им. проф. С.В. ОчаповскогоРоссияKuban State Medical University; Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1Russian FederationНаучно-исследовательский институт – Краевая клиническая больница № 1 им. проф. С.В. ОчаповскогоРоссияScientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1Russian Federation202630032026111116122Copyright © Медведев В.Л., Мануйлов В.Н., Стреляев А.И., Фоменко Ю.A., Лепетунов С.Н., 20262026Медведев В.Л., Мануйлов В.Н., Стреляев А.И., Фоменко Ю.A., Лепетунов С.Н.Medvedev V.L., Manuilov V.N., Strelyaev A.I., Fomenko Y.A., Lepetunov S.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.innovmedkub.ru/jour/article/view/1453Актуальность

Актуальность: Робот-ассистированная радикальная нефрэктомия с тромбэктомией из нижней полой вены при почечно-клеточном раке представляет собой сложное вмешательство, развитие которого требует оценки в сравнении с традиционным открытым методом.

Цель исследования

Цель исследования: Оценить эффективность, безопасность и технические особенности робот-ассистированной радикальной нефрэктомии с тромбэктомией из нижней полой вены.

Материалы и методы

Материалы и методы: Проведен систематический поиск литературы в базах данных (PubMed, Google Scholar, eLibrary) за 1987–2025 гг. по ключевым словам, связанным с понятием «почечно-клеточный рак», опухолевым тромбозом нижней полой вены и робот-ассистированной хирургией.

Заключение

Заключение: Обзор демонстрирует, что робот-асистированная радикальная нефрэктомия с тромбэктомией из нижней полой вены является выполнимой и безопасной альтернативой открытой операции, обеспечивая сопоставимое операционное время, но со значимыми преимуществами: снижением интраоперационной кровопотери, частоты гемотрансфузий, общего количества осложнений и продолжительности госпитализации. Внедрение метода требует междисциплинарного подхода, высокой квалификации хирургической команды и тщательного отбора пациентов. Для окончательного подтверждения эффективности и стандартизации методики необходимы дальнейшие многоцентровые проспективные исследования.

Background

Background: Robot-assisted radical nephrectomy with inferior vena cava (IVC) thrombectomy for renal cell carcinoma (RCC) is a complex intervention whose development requires evaluation in comparison with the traditional open method.

Objective

Objective: To evaluate the efficacy, safety, and technical features of robot-assisted radical nephrectomy (RARN) with IVC thrombectomy.

Materials and methods

Materials and methods: A systematic literature search was conducted in databases (PubMed, Google Scholar, eLibrary) from 1987 to 2025 using keywords related to RCC, IVC tumor thrombus, and robot-assisted surgery.

Conclusion

Conclusion: The review demonstrates that RARN with IVC thrombectomy is a feasible and safe alternative to open surgery, providing comparable operative time while offering significant advantages: reduced intraoperative blood loss, frequency of blood transfusions, overall complication rate, and length of hospital stay. Implementation of the method requires a multidisciplinary approach, highly qualified surgical team, and careful patient selection. Further multicenter prospective studies are necessary for final confirmation of efficacy and standardization of the technique.

почечно-клеточный ракопухолевый тромб нижней полой веныробот-ассистированная хирургиярадикальная нефрэктомиятромбэктомияrenal cell carcinomainferior vena cava tumor thrombusrobot-assisted surgeryradical nephrectomythrombectomyReferencesAmerican Cancer Society. Key Statistics about Kidney Cancer; American Cancer Society. Last revised January 16, 2025.American Cancer Society. Key Statistics about Kidney Cancer; American Cancer Society. Last revised January 16, 2025.Каприн А.Д., Старинский В.В., Шахзадова А.О. Злокачественные новообразования в России в 2020 году (заболеваемости и смертность). М.: МНИОИ им. П.А. Герцена − филиал ФГБУ «НМИЦ радиологии» Минздрава России. 2021; 252 с.Kaprin AD, Starinsky VV, Shakhzadov OA. Malignant Neoplasms in Russia in 2020 (Incidence and Mortality). Moscow, Russia: P.A. Herzen Moscow Research Institute of Oncology – Branch of the National Medical Research Center of Radiology, Ministry of Health of the Russian Federation; 2021:252 p.Almatari AL, Sathe A, Wideman L, et al. Renal cell carcinoma with tumor thrombus: A review of relevant anatomy and surgical techniques for the general urologist. Urol Oncol. 2023;41(4):153-165. PMID: 36804205. https://doi.org/10.1016/j.urolonc.2022.11.021Almatari AL, Sathe A, Wideman L, et al. Renal cell carcinoma with tumor thrombus: A review of relevant anatomy and surgical techniques for the general urologist. Urol Oncol. 2023;41(4):153-165. PMID: 36804205. https://doi.org/10.1016/j.urolonc.2022.11.021Takahara K, Takenaka M, Zennami K, et al. Robot-assisted radical nephrectomy with inferior vena cava thrombectomy: a case report. Transl Cancer Res. 2023;12(12):3792-3798. PMID: 38197070. PMCID: PMC10774061. https://doi.org/10.21037/tcr-23-855Takahara K, Takenaka M, Zennami K, et al. Robot-assisted radical nephrectomy with inferior vena cava thrombectomy: a case report. Transl Cancer Res. 2023;12(12):3792-3798. PMID: 38197070. PMCID: PMC10774061. https://doi.org/10.21037/tcr-23-855Rodriguez Faba O, Linares E, Tilki D, et al. Impact of Microscopic Wall Invasion of the Renal Vein or Inferior Vena Cava on Cancer-specific Survival in Patients with Renal Cell Carcinoma and Tumor Thrombus: A Multi-institutional Analysis from the International Renal Cell Carcinoma-Venous Thrombus Consortium. Eur Urol Focus. 2018;4(3):435-441. PMID: 28753848. https://doi.org/10.1016/j.euf.2017.01.009Rodriguez Faba O, Linares E, Tilki D, et al. Impact of Microscopic Wall Invasion of the Renal Vein or Inferior Vena Cava on Cancer-specific Survival in Patients with Renal Cell Carcinoma and Tumor Thrombus: A Multi-institutional Analysis from the International Renal Cell Carcinoma-Venous Thrombus Consortium. Eur Urol Focus. 2018;4(3):435-441. PMID: 28753848. https://doi.org/10.1016/j.euf.2017.01.009Ma S, Jia W, Hou G, et al. Case reports of robot-assisted laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy: A retrospective analysis. Medicine (Baltimore). 2021;100(33):e26886. PMID: 34414942. PMCID: PMC8376354. https://doi.org/10.1097/md.0000000000026886Ma S, Jia W, Hou G, et al. Case reports of robot-assisted laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy: A retrospective analysis. Medicine (Baltimore). 2021;100(33):e26886. PMID: 34414942. PMCID: PMC8376354. https://doi.org/10.1097/md.0000000000026886Ciancio G, Manoharan M, Katkoori D, De Los Santos R, Soloway MS. Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: single-center experience. Eur Urol. 2010;57(4):667-672. PMID: 19560258. https://doi.org/10.1016/j.eururo.2009.06.009Ciancio G, Manoharan M, Katkoori D, De Los Santos R, Soloway MS. Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: single-center experience. Eur Urol. 2010;57(4):667-672. PMID: 19560258. https://doi.org/10.1016/j.eururo.2009.06.009Abaza R. Initial series of robotic radical nephrectomy with vena caval tumor thrombectomy. Eur Urol. 2011;59(4):652-656. PMID: 20846783. https://doi.org/10.1016/j.eururo.2010.08.038Abaza R. Initial series of robotic radical nephrectomy with vena caval tumor thrombectomy. Eur Urol. 2011;59(4):652-656. PMID: 20846783. https://doi.org/10.1016/j.eururo.2010.08.038Neves RJ, Zincke H. Surgical treatment of renal cancer with vena cava extension. Br J Urol. 1987;59(5):390-395. PMID: 3594097. https://doi.org/10.1111/j.1464-410x.1987.tb04832.xNeves RJ, Zincke H. Surgical treatment of renal cancer with vena cava extension. Br J Urol. 1987;59(5):390-395. PMID: 3594097. https://doi.org/10.1111/j.1464-410x.1987.tb04832.xCiancio G, Vaidya A, Savoie M, Soloway M. Management of renal cell carcinoma with level III thrombus in the inferior vena cava. J Urol. 2002;168(4 Pt 1):1374-1377. PMID: 12352396. https://doi.org/10.1016/s0022-5347(05)64452-7Ciancio G, Vaidya A, Savoie M, Soloway M. Management of renal cell carcinoma with level III thrombus in the inferior vena cava. J Urol. 2002;168(4 Pt 1):1374-1377. PMID: 12352396. https://doi.org/10.1016/s0022-5347(05)64452-7Wang K, Liu Z, Hong P, et al. T.H.R.O.B.V.S. Score – A Comprehensive Model to Predict the Surgical Complexity of Renal Cell Carcinoma With Tumor Thrombus. Front Oncol. 2022;12:900550. PMID: 35814463. PMCID: PMC9261335. https://doi.org/10.3389/fonc.2022.900550Wang K, Liu Z, Hong P, et al. T.H.R.O.B.V.S. Score – A Comprehensive Model to Predict the Surgical Complexity of Renal Cell Carcinoma With Tumor Thrombus. Front Oncol. 2022;12:900550. PMID: 35814463. PMCID: PMC9261335. https://doi.org/10.3389/fonc.2022.900550Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. 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. PMID: 15217427. https://doi.org/10.1111/j.1464-410x.2004.04897.xBlute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. 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. PMID: 15217427. https://doi.org/10.1111/j.1464-410x.2004.04897.xZhang X, Wang B. Robot-assisted Surgery for Renal Cell Carcinoma with Caval Thrombosis. Eur Urol Focus. 2018;4(5):639-640. PMID: 30181053. https://doi.org/10.1016/j.euf.2018.06.003Zhang X, Wang B. Robot-assisted Surgery for Renal Cell Carcinoma with Caval Thrombosis. Eur Urol Focus. 2018;4(5):639-640. PMID: 30181053. https://doi.org/10.1016/j.euf.2018.06.003Huang Q, Zhao G, Chen Y, 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. PMID: 36194169. https://doi.org/10.1097/ju.0000000000002952Huang Q, Zhao G, Chen Y, 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. PMID: 36194169. https://doi.org/10.1097/ju.0000000000002952Матвеев В.Б., Стилиди И.С., Волкова М.И., и др. Нефрэктомия, тромбэктомия у больных раком почки с протяженным опухолевым венозным тромбозом: как выполнить операцию с минимальным риском для пациента?. Онкоурология. 2021;1:19-30.Matveev VB, Stilidi IS, Volkova MI, et al. Nephrectomy and thrombectomy in renal cell carcinoma patients with extensive tumor venous thrombosis how to minimize surgical risks? Onkourologiya. 2021;1:19-30. (In Russ.).Волкова М.И., Вашакмадзе Н.Л., Климов А.В. и др. Прогноз оперированных больных раком почки с опухолевым венозным тромбозом: опыт клиники урологии НМИЦ онкологии им. Н.Н. Блохина. Онкоурология. 2021;17(3):19–28. https://doi.org/10.17650/1726-9776-2021-17-3-19-28Volkova MI, Vashakmadze NL, Klimov AV, Begaliev AK, Kuznetsov KP, Matveev VB. Prognosis of patients operated on for renal cell carcinoma and tumor venous thrombosis: experience of the Urology Clinics, N.N. Blokhin National Medical Research Center of Oncology. Cancer Urology. 2021;17(3):19–28. (In Russ.). https://doi.org/10.17650/1726-9776-2021-17-3-19-28Almatari AL, Sathe A, Wideman L, et al. Renal cell carcinoma with tumor thrombus: A review of relevant anatomy and surgical techniques for the general urologist. Urol Oncol. 2023;41(4):153-165. PMID: 36804205. https://doi.org/10.1016/j.urolonc.2022.11.021Almatari AL, Sathe A, Wideman L, et al. Renal cell carcinoma with tumor thrombus: A review of relevant anatomy and surgical techniques for the general urologist. Urol Oncol. 2023;41(4):153-165. PMID: 36804205. https://doi.org/10.1016/j.urolonc.2022.11.021Wang B, Li H, Ma X, et al. Robot-assisted Laparoscopic Inferior Vena Cava Thrombectomy: Different Sides Require Different Techniques. Eur Urol. 2016;69(6):1112-1119. PMID: 26706105. https://doi.org/10.1016/j.eururo.2015.12.001Wang B, Li H, Ma X, et al. Robot-assisted Laparoscopic Inferior Vena Cava Thrombectomy: Different Sides Require Different Techniques. Eur Urol. 2016;69(6):1112-1119. PMID: 26706105. https://doi.org/10.1016/j.eururo.2015.12.001Psutka SP, Leibovich BC. Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma. Ther Adv Urol. 2015;7(4):216-229. PMID: 26445601. PMCID: PMC4580091. https://doi.org/10.1177/1756287215576443Psutka SP, Leibovich BC. Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma. Ther Adv Urol. 2015;7(4):216-229. PMID: 26445601. PMCID: PMC4580091. https://doi.org/10.1177/1756287215576443Abaza R, Shabsigh A, Castle E, et al. Multi-Institutional Experience with Robotic Nephrectomy with Inferior Vena Cava Tumor Thrombectomy. J Urol. 2016;195(4 Pt 1):865-871. PMID: 26602891. https://doi.org/10.1016/j.juro.2015.09.094Abaza R, Shabsigh A, Castle E, et al. Multi-Institutional Experience with Robotic Nephrectomy with Inferior Vena Cava Tumor Thrombectomy. J Urol. 2016;195(4 Pt 1):865-871. PMID: 26602891. https://doi.org/10.1016/j.juro.2015.09.094Wang B, Li H, Huang Q, 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. PMID: 29223604. https://doi.org/10.1016/j.eururo.2017.11.017Wang B, Li H, Huang Q, 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. PMID: 29223604. https://doi.org/10.1016/j.eururo.2017.11.017Chopra S, Simone G, Metcalfe C, et al. Robot-assisted Level II-III Inferior Vena Cava Tumor Thrombectomy: Step-by-Step Technique and 1-Year Outcomes. Eur Urol. 2017;72(2):267-274. PMID: 27663048. PMCID: PMC9084628. https://doi.org/10.1016/j.eururo.2016.08.066Chopra S, Simone G, Metcalfe C, et al. Robot-assisted Level II-III Inferior Vena Cava Tumor Thrombectomy: Step-by-Step Technique and 1-Year Outcomes. Eur Urol. 2017;72(2):267-274. PMID: 27663048. PMCID: PMC9084628. https://doi.org/10.1016/j.eururo.2016.08.066Gill IS, Metcalfe C, Abreu A, et al. Robotic Level III Inferior Vena Cava Tumor Thrombectomy: Initial Series. J Urol. 2015;194(4):929-938. PMID: 25858419. PMCID: PMC9083507. https://doi.org/10.1016/j.juro.2015.03.119Gill IS, Metcalfe C, Abreu A, et al. Robotic Level III Inferior Vena Cava Tumor Thrombectomy: Initial Series. J Urol. 2015;194(4):929-938. PMID: 25858419. PMCID: PMC9083507. https://doi.org/10.1016/j.juro.2015.03.119Tang G, Chen X, Wang J, He W, Niu Z. Adjuvant instant preoperative renal artery embolization facilitates the radical nephrectomy and thrombectomy in locally advanced renal cancer with venous thrombus: a retrospective study of 54 cases. World J Surg Oncol. 2020;18(1):206. PMID: 32795311. PMCID: PMC7427865. https://doi.org/10.1186/s12957-020-01985-7Tang G, Chen X, Wang J, He W, Niu Z. Adjuvant instant preoperative renal artery embolization facilitates the radical nephrectomy and thrombectomy in locally advanced renal cancer with venous thrombus: a retrospective study of 54 cases. World J Surg Oncol. 2020;18(1):206. PMID: 32795311. PMCID: PMC7427865. https://doi.org/10.1186/s12957-020-01985-7Schwartz MJ, Smith EB, Trost DW, Vaughan ED Jr. Renal artery embolization: clinical indications and experience from over 100 cases. BJU Int. 2007;99(4):881-886. PMID: 17166242. https://doi.org/10.1111/j.1464-410x.2006.06653.xSchwartz MJ, Smith EB, Trost DW, Vaughan ED Jr. Renal artery embolization: clinical indications and experience from over 100 cases. BJU Int. 2007;99(4):881-886. PMID: 17166242. https://doi.org/10.1111/j.1464-410x.2006.06653.xZhang Y, Bi H, Fu Y, et al. Cephalic inferior vena cava non-clamping technique versus standard procedure for robot-assisted laparoscopic level II-III thrombectomy: a prospective cohort study. Int J Surg. 2023;109(6):1594-1602. PMID: 37131326. PMCID: PMC10389522. https://doi.org/10.1097/js9.0000000000000209Zhang Y, Bi H, Fu Y, et al. Cephalic inferior vena cava non-clamping technique versus standard procedure for robot-assisted laparoscopic level II-III thrombectomy: a prospective cohort study. Int J Surg. 2023;109(6):1594-1602. PMID: 37131326. PMCID: PMC10389522. https://doi.org/10.1097/js9.0000000000000209Kundavaram C, Abreu AL, Chopra S, et al. Advances in Robotic Vena Cava Tumor Thrombectomy: Intracaval Balloon Occlusion, Patch Grafting, and Vena Cavoscopy. Eur Urol. 2016;70(5):884-890. PMID: 27423505. https://doi.org/10.1016/j.eururo.2016.06.024Kundavaram C, Abreu AL, Chopra S, et al. Advances in Robotic Vena Cava Tumor Thrombectomy: Intracaval Balloon Occlusion, Patch Grafting, and Vena Cavoscopy. Eur Urol. 2016;70(5):884-890. PMID: 27423505. https://doi.org/10.1016/j.eururo.2016.06.024Alahmari A, Alzahrani Z, Algarni KS, et al. Robotic inferior vena cava thrombectomy using a novel intracaval balloon occlusion technique. Cent European J Urol. 2020;73(1):106-107. PMID: 32395333. PMCID: PMC7203777. https://doi.org/10.5173/ceju.2020.0014Alahmari A, Alzahrani Z, Algarni KS, et al. Robotic inferior vena cava thrombectomy using a novel intracaval balloon occlusion technique. Cent European J Urol. 2020;73(1):106-107. PMID: 32395333. PMCID: PMC7203777. https://doi.org/10.5173/ceju.2020.0014Rose KM, Navaratnam AK, Faraj KS, et al. Comparison of Open and Robot Assisted Radical Nephrectomy With Level I and II Inferior Vena Cava Tumor Thrombus: The Mayo Clinic Experience. Urology. 2020;136:152-157. PMID: 31733271. https://doi.org/10.1016/j.urology.2019.11.002Rose KM, Navaratnam AK, Faraj KS, et al. Comparison of Open and Robot Assisted Radical Nephrectomy With Level I and II Inferior Vena Cava Tumor Thrombus: The Mayo Clinic Experience. Urology. 2020;136:152-157. PMID: 31733271. https://doi.org/10.1016/j.urology.2019.11.002Beksac AT, Shah QN, Paulucci DJ, et al. Trends and outcomes in contemporary management renal cell carcinoma and vena cava thrombus. Urol Oncol. 2019;37(9):576.e17-576.e23. PMID: 31174956. https://doi.org/10.1016/j.urolonc.2019.05.010Beksac AT, Shah QN, Paulucci DJ, et al. Trends and outcomes in contemporary management renal cell carcinoma and vena cava thrombus. Urol Oncol. 2019;37(9):576.e17-576.e23. PMID: 31174956. https://doi.org/10.1016/j.urolonc.2019.05.010

The authors declare that there are no conflicts of interest present.