[Left-sided renal cell cacrinoma with vena cava inferior thrombus: totally laparoscopic removal]

Abstract

A surgical treatment of patients with tumor thrombus in the inferior vena cava (IVC) of levels II-III, originating from the left renal vein involves performing thrombectomy, radical nephrectomy and lymph nodes dissection. In most cases it requires major open surgery which leads to complications in 38% of patients and perioperative mortality of 4-10%. In recent years, the laparoscopic radical nephrectomy with thrombectomy have been gradually introduced. However, there are anecdotal reports about performing of such interventions in case of left-sided renal tumor with thrombus in the IVC. A description of technique and own experience of performing laparoscopic radical nephrectomy with thrombectomy from the IVC in 3 patients with tumor thrombus of levels II-III, originating from left kidney are presented. In one case distant metastases were detected preoperatively and in another patient an involvement of tail of the pancreas by the tumor was diagnosed. There was no conversion to open surgery. The maximum tumor size ranged from 5 to 16 cm. The length of tumor thrombus in the IVC was 2.4-7 cm and estimated blood loss was 300-2500 ml. In one case a blood transfusion was required postoperatively. The follow-up period was 4-26 months. One patient died from progression of the disease after 5 months, two other patients are alive without any signs of relapse. The initial experience of laparoscopic radical nephrectomy with thrombectomy from IVC in patients with left-sided renal cell cancer suggests that this technique is reproducible and relatively safe with respecting of basic principles of oncology and vascular surgery. The surgery is not associated with major perioperative complications, significant blood loss and is accompanied by a rather favorable postoperative period. An accumulation of a larger number of cases is needed to assess the oncological results of this technique.

Keywords: laparoscopic thrombectomy; renal cell carcinoma; tumor thrombus; vena cava inferior.