Retroperitoneal laparoscopic radical nephrectomy and thrombectomy for renal tumor with renal vein and vena cava thrombus

Objective To evaluate the feasibility of retroperitoneal laparoscopic radical nephrectomy and thrombectomy for renal tumor with renal vein and vena cava thrombus.Methods Twelve cases of renal tumor with renal vein and vena cava thrombus were reported.Contrast-enhanced CT showed renal tumor extended to renal vein and vena cava in two cases,and filling defects were found in right or left renal vein in ten cases.All the patients received retroperitoneal laparoscopic radical nephrectomy and thrombectomy.Four trocars were placed during the procedure,early arterial division and "milking" of the thrombus away from the inferior vena cava may facilitate laparoscopic surgery,a laparoscopic clamp was used to occlude the vena cava partially containing the thrombus in two cases.Hem-o-lok was used to dissect the renal vein for left renal tumors.During the operation,inferior mesenteric artery,abdominal aorta and inferior vena cava were mobilized in order to expand the operating space.Results One patient was conver~d to open procedure.The two right tumor thrombi were 2.5 cm and 3.7 cm,respectively.The mean length of left tumor thrombi was 4.1 cm (2.0-7.5 cm).Post-operative pathology showed renal epithelioid angiomyolipoma in one patient,clear cell carcinoma in 9 cases (grade 1 in 2 cases,grade 1-2 in 2 cases,grade 2 in 5 cases),chromophobe carcinoma in 1 case and renal pelvic urothelial carcinoma in 1 case.Mean hospital stay was 7 d (4-11 d).Contralateral adrenal metastasis occurred in one case 14 months after surgery.No tumor recurrence or metastasis occurred with a mean follow-up of 20 months (5-42 months) for others.Conclusion Retroperitoneal laparoscopic radical nephrectomy and thrombectomy can be applied safely and effectively with adherence to proper techniques in carefully selected patients. Key words: Kidney neoplasms ;  Thrombus ;  Laparoscopic ;  Nephrectomy ;  Thrombectomy