Laparoscopic Management of Advanced Renal Cell Carcinoma With Renal Vein and Inferior Vena Cava Thrombus

ObjectiveTo report the results and oncological efficacy of laparoscopic radical nephrectomy (LRN) in patients with renal cell carcinoma with renal vein and inferior vena cava thrombus.MethodsWe performed retrospective record review of 41 patients who underwent LRN along with venous thrombectomy at 2 Canadian centers from 2002 to 2012 by dedicated laparoscopic surgeons.ResultsThe mean age and body mass index of the 41 study patients (34 males and 7 female) were 64.4 years and 28.7 kg/m2, respectively. Median tumor size was 9.3 cm; 39 patients had renal vein thrombus, and 2 had inferior vena cava thrombus. Nine patients (22%) had metastatic disease to begin with and underwent laparoscopic cytoreductive nephrectomy. Median estimated blood loss, operative time, and length of stay were 100 mL (range, 50-400 mL), 134.5 minutes (range, 99-183 minutes), and 4 days (range, 4-6 days), respectively. There were 4 (9.7%) grade 2 complications. There was no intraoperative death. Mean duration of follow-up was 42 months (range, 6-107 months). Of 32 patients with localized disease, 4 (12.5%) died of progressive disease, 3 (9.3%) died of unrelated causes, and 3 patients (9.3%) were lost to follow-up. Twenty-two patients (68.7%) were alive at a mean follow-up of 47 months.ConclusionLRN and venous thrombectomy for advanced renal tumors with venous thrombus are safe procedures in experienced hands with significant laparoscopic skills. The short-term oncological data are encouraging and advocate the efficacy of this procedure in this subset of patients, although longer follow-up is required in larger number of patients to further define its role.