Laparoscopic management of advanced renal cell carcinoma with level I renal vein thrombus

Kapoor, Anil; Nguan, Christopher; Al-Shaiji, Tariq F.; Hussain, Abdullatif; Fazio, Luke M.; Omar, Mohammed Al; Luke, Patrick

doi:10.1016/j.urology.2006.03.031

Cited by 31 publications

(21 citation statements)

References 15 publications

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“…We did not utilize intraoperative ultrasound to confirm the presence and extension of the renal vein thrombus. We recognize the validity of its use in this setting, as reported by other investigators [10,12]. However, in our experience, we found that after the renal artery had been ligated, the tumor thrombus became evident, as the renal vein drained out and flattened, while the area where the tumor was present remained protuberant.…”

Section: Discussionsupporting

confidence: 80%

“…Several studies have demonstrated cancer control outcomes comparable to its open counterpart [10,11]. As urologic surgeons have become more experienced, the indications of LRN have broadened to include higher stage tumors, as well as for cytoreduction purposes [12,13].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, small series and isolated cases of selected patients undergoing LRN with thrombectomy for level 1 renal vein thrombus have been reported [14,15]. Although higher quality evidence is still low from published studies, this procedure may be safe and feasible, with a potential oncologic benefit of the minimally invasive approach over the open one, as shorter postoperative convalescence can allow adjuvant therapy to be initiated more promptly for the patient requiring it [10,13]. Long-term results are lacking in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Management of Renal Tumors with Macroscopic Level 1 Renal Vein Involvement

Castillo¹,

Silva²,

Alemán³

2014

Urol Int

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Objective: To describe our surgical experience and clinical outcome in laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) with level 1 renal vein tumor thrombus. Patients and Methods: 11 patients with RCC level 1 renal vein tumor thrombus were treated by LRN plus thrombectomy. The mean age was 66.8 years (SD ±11.313); the mean body mass index was 24.76 (SD ±5.091). In all cases, the surgical technique was defined by tumor characteristics and the surgeon's preferences. Results: Surgery was technically successful in all 11 patients. A hand-assisted approach was performed in 3 patients, while pure laparoscopy was used in 8. The mean surgical time was 108.3 min (SD ±28.284); the mean estimated blood loss was 108.33 ml (SD ±106.066); the average hospital stay was 2.8 days (SD ±0.707). There was 1 intraoperative complication (splenic laceration) that was managed laparoscopically. Pathologic examination confirmed RCC in all cases. There were no positive surgical margins. With a mean follow-up of 29 months (27-39), 2 patients had a recurrence. Conclusion: This report provides further evidence of the technical feasibility, safety and oncologic adequacy of the laparoscopic approach in RCC with level 1 renal vein involvement. A longer follow-up and multi-institutional studies are needed to adequately evaluate its potential oncologic benefit.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic Management of Renal Tumors with Macroscopic Level 1 Renal Vein Involvement

Castillo¹,

Silva²,

Alemán³

2014

Urol Int

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“…The first case-report description of a laparoscopic nephrectomy with the thrombus extending into the renal vein (level I) was by Savage et al in 2000 (5). Subsequently, the technical feasibility of this approach was confirmed by our group and others (6,7).…”

Section: Introductionmentioning

confidence: 77%

“…Our group has previously reported that laparoscopic resection of renal tumors with level I renal vein thrombi is feasible with and without the use of laparoscopic ultrasound and hand assistance (6). Accordingly, the Doppler ultrasound can distinguish the location of the tip of the tumor thrombus, thereby providing a safe window through which the laparoscopic stapler can be applied.…”

Section: Commentsmentioning

confidence: 99%

Hand-assisted laparoscopic radical nephrectomy in the treatment of a renal cell carcinoma with a level ii vena cava thrombus

Kovac

Luke

2010

Int. braz j urol.

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Excision of renal cell carcinoma (RCC) with corresponding vena cava thrombus is a technical challenge requiring open resection and vascular clamping. A 58 year old male with a right kidney tumor presented with a thrombus extending 1 cm into the vena cava. Using a hand-assisted transperitoneal approach through a 7 cm gel-port, the right kidney was dissected and the multiple vascular collaterals supplying the tumor were identified and isolated. The inferior vena cava was mobilized 4 cm cephalad and 4 cm caudal to the right renal vein. Lateral manual traction was applied to the right kidney allowing the tumor thrombus to be retracted into the renal vein, clear of the vena cava. After laparoscopic ultrasonographic confirmation of the location of the tip of the tumor thrombus, an articulating laparoscopic vascular stapler was used to staple the vena cava at the ostium of the right renal vein. This allowed removal of the tumor thrombus without the need for a Satinsky clamp. The surgery was completed in 243 minutes with no intra-operative complications. The entire kidney and tumor thrombus was removed with negative surgical margins. Estimated blood loss was 300 cc. We present a laparoscopic resection of a renal mass with associated level II thrombus using a hand-assisted approach. In patients with minimal caval involvement, our surgical approach presents an option to the traditional open resection of a renal mass.

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Basic Hand‐assisted Laparoscopic Techniques

Ambani

Wolf

2018

Smith's Textbook of Endourology

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Laparoscopic management of advanced renal cell carcinoma with level I renal vein thrombus

Cited by 31 publications

References 15 publications

Laparoscopic Management of Renal Tumors with Macroscopic Level 1 Renal Vein Involvement

Laparoscopic Management of Renal Tumors with Macroscopic Level 1 Renal Vein Involvement

Hand-assisted laparoscopic radical nephrectomy in the treatment of a renal cell carcinoma with a level ii vena cava thrombus

Basic Hand‐assisted Laparoscopic Techniques

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