En bloc retroperitoneal laparoscopic radical nephrectomy with inferior vena cava thrombectomy for renal cell carcinoma with level 0 to II venous tumor thrombus: A single‐center experience

Abstract

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.

Urothelial carcinoma of the renal pelvis with renal vein and inferior vena cava tumor thrombus: case series and literature review

“…All surgeries were performed for curative purpose. The surgical steps of radical nephrectomy and thrombectomy in our center were described in the previous publication (32), but we performed radical nephroureterectomy and thrombectomy when preoperative diagnosis was UC. For level-0 TT, renal vein was clamped before the entrance to IVC.…”

Surgical and Oncologic Outcomes of Laparoscopic Versus Open Radical Nephrectomy with Venous Thrombectomy: A Propensity-Matched Retrospective Cohort Study

“…The techniques of LRN-VT and ORN-VT at our institution have been described previously [8,[12][13][14]. For LRN-VT, both transperitoneal approach and retroperitoneal approach were used in our center depending on the thrombus level, tumor side, surgery history and invading the IVC wall or not.…”

“…For level II thrombus, Wang et al [22] reported the surgical outcomes of laparoscopic procedure in 5 patients and found that 1 patient required intraoperative transfusion and encountered bilateral lower limb deep vein thrombus. Tian et al [8] once presented our laparoscopic experience in 78 patients with level 0-II thrombus and found that 24 patients (30.8%) needed transfusion and 13 patients (16.7%) had complications. Of the 94 patients in our matched LRN-VT cohort, 38 (40.4%) patients needed transfusion and 20 patients (21.3%) had Clavien I-IV complications.…”

“…Open surgery remains the preferred treatment option [4]. Nevertheless, several reports have introduced the application and confirmed the feasibility of pure laparoscopy or handassisted laparoscopy in RN-VT [5][6][7][8][9][10]. Until now, less literature reported the comparative analysis between laparoscopic radical nephrectomy with venous thrombectomy (LRN-VT) and open radical nephrectomy with venous thrombectomy (ORN-VT) in patients with renal tumor and venous thrombus.…”

Modified IVC Clamping Technique in the Left Radical Nephrectomy and Mayo II-III IVC Thrombectomy: A Preliminary Experience

“…The detailed steps of RPL-RN for left RCC were described in our previous report [16]. The difference is that after the left nephrectomy, the peritoneum should be incised about 10cm at the left paracolic sulci, preparing for the take of the specimen.…”