Background: The surgical treatment of patients with renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is challenging. In the current study, the authors have reported their surgical outcomes and experience with en bloc retroperitoneal laparoscopic radical nephrectomy (LRN) with inferior vena cava (IVC) thrombectomy for patients with RCC with level 0 to II VTT.
Methods: A retrospective review of the clinical records of 78 patients who underwent retroperitoneal LRN with IVC thrombectomy from March 2015 to September 2018 was performed. The surgical procedures included establishing the retroperitoneal space, ligating and severing the renal artery, clamping the renal vein and IVC, incising the IVC, and placing the renal and tumor thrombus en bloc into a retrieval bag.
Results: According to the Mayo classification, the tumor thrombus was level 0, I, and II, respectively, in 28 patients, 27 patients, and 23 patients. The median operative time, estimated blood loss, and postoperative hospital stay were 256 minutes, 400 mL, and 8 days, respectively. A total of 67 patients were not converted to open surgery. No patient died during surgery, and no tumor embolization occurred. Thirteen patients experienced complications. The pathological reports indicated clear cell RCC in 70 patients and other RCC in 8 patients. The median follow-up was 14.5 months, and 61 patients were alive at the time of last follow-up.
Conclusions: En bloc retroperitoneal LRN with IVC thrombectomy is a challenging but feasible procedure for experienced surgeons in patients with RCC with level 0 to II VTT.
Keywords: laparoscopic surgery; renal cell carcinoma; retroperitoneal; venous tumor thrombus.
© 2020 American Cancer Society.