How to Manage Large Renal-Cell Carcinoma in Laparoscopic Nephrectomy

Abstract Introduction: Large renal-cell carcinoma (RCC) has more vascularity and a greater influence on adjacent organs.1 We will present several cases of large tumors with preoperative radiological findings. Materials and Methods: Eighty-eight patients with large RCC underwent laparoscopic radical nephrectomy between 1997 and 2009. There were eight cases (9%) of intraoperative complications: four vascular complications and four adjacent organ injuries. Results: Case 1: An 81-year-old man with a right RCC. Preoperative magnetic resonance imaging showed that the duodenum had adhered to the anterior surface of the kidney. After clamping the renal artery, we revealed the anterior surface of the renal vein and separated the duodenum from the kidney. Case 2: A 64-year-old man with a left upper pole RCC. The tumor protruded medially and compressed the pancreas. When the kidney was turned posteriorly for anterior dissection after completion of renal hilum, the dissection injured the pancreas. Prior dissection be...