Overcoming fear of developing country: A case report of retroperitoneal laparoscopic partial nephrectomy for T3A renal cell carcinoma

Abstract

Introduction: Renal cell carcinoma poses significant challenges in kidney diseases, particularly in the context of the T3 stage, where treatment strategies remain controversial. The utilization of laparoscopic partial nephrectomy, particularly in developing countries, has been restricted for such patients, primarily due to limited infrastructure and concerns about recurrence risk and long-term pathologic outcomes.

Presentation of case: In this report, we present a case of a 64-year-old male diagnosed with T3aN0M0 renal cell carcinoma (RCC). Abdominal computed tomography revealed a 5.2 × 5.2 × 5.1 cm mass on the right upper part of the kidney with a possible thrombus in the superior renal polar vein. The patient underwent successful treatment with retroperitoneal laparoscopic partial nephrectomy (LPN), leading to the preservation of kidney function with <4 mL/min/1.73 m2 GFR reduced after one year postoperative (estimated GFR from 85 mL/min/1.73 m2 to 81.79 mL/min/1.73 m2). The patient was discharged after three days; no recurrence was observed during the follow-up.

Discussion: For stage T3a RCC, studies show that LPN induces comparable long-term outcomes to radical nephrectomy, with advantages such as preserved kidney function, reduced operative time, blood loss, and shorter hospital stays. However, due to infrastructure constraints and limited access to robotic-assisted surgery in our country, coupled with concerns about tumor recurrence, laparoscopic radical nephrectomy is predominantly employed for similar patients. Our case represents one of the very first cases in which we successfully treated a patient diagnosed with T3a RCC using retroperitoneal laparoscopic partial nephrectomy.

Conclusion: Laparoscopic partial nephrectomy is a reliable choice for T3aN0M0 RCC with good long-term outcomes and preserved renal function, especially by the hands of an experienced laparoscopic surgeon.

Keywords: Developing countries; Partial nephrectomy; Preserved kidney function; Renal cell carcinoma; T3a stage.

Fig. 1

A. Image of upper pole kidney tumor (P) d#52 × 51 × 52 mm measuring 52 × 51 × 52 mm (yellow arrow) characterized by contrast enhancement in the arterial phase and wash-out in the venous phase. There is no evidence of invasion into the renal capsule or renal sinus. B. Evidence of renal vein thrombus (red arrow) estimated 9–11 mm. There is no observed invasion into the vena cava.

Fig. 2

A. Fatty tissue was tumor cell-free in cold biopsy. B. Gross anatomy of the tumor with thrombus in the renal vein (yellow star). C. Cross-sectional image of the tumor with renal vein thrombus (yellow star). D. Image of clear cell renal cell carcinoma, which invaded the renal capsule but did not involve surrounding fatty tissue (black arrow). The cut edge showed no malignant cells (white arrow).

Fig. 3

Contrast-enhanced CT images six months (A) and one year (B) after surgery showed no tumor recurrence.