Abstract: PD20-02
Sources of Funding: None

Introduction

Management of renal cell carcinoma (RCC) with tumor thrombus extending to the renal vein and inferior vena cava (IVC) is very challenging. The aim of this study was to evaluate the benefit of pure retroperitoneal laparoscopic radical nephrectomy with inferior vena cava thrombectomy in such patients.

Methods

From Jan 2014 to Sep 2016, 18 patients underwent laparoscopic radical nephrectomy for renal cell cancer combined with tumor thrombus of the inferior vena cava. Thrombus extension classified by the Mayo Clinic and the 2009 TNM classifications, complications, postoperative management, and survival results were analyzed. The surgeries were preformed by retroperitoneal approach totally. For substantial level I-II involvement, complete caval isolation, including laparoscopic control of infra-renal and supra-renal IVC, contra-lateral renal vein and lumbar veins was performed. ? Following thrombus extraction, the cavotomy was repaired with 4-0 prolene suture on RB-1 needle.

Results

Of these patients, 8 patients had level I, 10 had level II thrombi according to the Mayo Clinic staging. Totally retroperitoneal laparoscopic approach was performed in patients with stage I to II thrombi. There was no intraoperative mortality and open conversion. The median follow-up interval was 13.6 months. Metastatic diseases did not develop in any patient.

Conclusions

The tumor thrombus level with IVC determines the surgical approach and method. Our results show that Mayo level I-II caval vein tumor thrombus can be safely surgically treated by pure retroperitoneal laparotomy.

Funding

None