Laparoscopic radical nephrectomy with inferior vena cava level I–III thrombectomy: experience of one center and literature review

Abstract

Objective. Radical nephrectomy with thrombectomy of the inferior vena cava is the preferred treatment for renal cell carcinoma with an tumor thrombosis. We describe our experience and presentreview of the literature evaluating the feasibility and safety of laparoscopic nephrectomy with inferior vena cava thrombectomy.Materials and methods. The study included 37 patients who underwent laparoscopic radical nephrectomy with level I–III thrombectomy for renal cell carcinoma in our institution from 2018 to 2021. We analyzed the clinical, radiographic, intraoperative, pathological and postoperative parameters of the patients. The literature was reviewed by the Medline search engine, PubMed, with a review of publications on laparoscopic radical nephrectomy with inferior vena cava levelI–IIIthrombectomy.Results. The mean operation time was 275 ± 60.1 min, the median blood loss was 450 ± 81.6 ml (≥50 % of the circulating blood volume – 32.4 %). Intraoperative complications were observed during 10 (27.0 %) operations. Postoperative complications developed in 29.7 % of patients and reached gradesIII–IV according to the Clavien–Dindo scale on 13.0 % ill. All patients are activated according to the fast track rehabilitation program. The average hospital stay was 5 days. A literature review identified clinical cases and small series demonstrating the technical feasibility and safety of laparoscopic radical nephrectomy with thrombectomy in selected patients.Conclusion. Laparoscopic radical nephrectomy with thrombectomy is a technically feasible approach in carefully selected patients with level I–III tumor thrombosis. Optimal patient selection, extensive experience in laparoscopy and specialized centers are essential for the safe use of thistechnique.