V06-08: Robotic Radical Adrenalectomy For Pheochromocytoma Associated With Adrenal And Renal Vein Tumor Thrombectomy
Venous tumor thrombus due to an adrenal mass is rare, with published reports limited to individual cases and majority of them associated with adrenal cortical carcinoma. An adrenal and renal vein tumor thrombus due to a pheochromocytoma is exceedingly rare. To our knowledge, there have been no prior reports of a pheochromocytoma with adrenal and renal vein tumor thrombus managed robotically. Here we describe our technique of adrenal and renal vein tumor thrombectomy during a robotic left radical adrenalectomy.
A 38 year-old gentleman presented with a left adrenal mass. Imaging studies revealed a left adrenal mass with left adrenal and renal vein tumor thrombus. Metabolic studies were suggestive of a pheochromocytoma. He was taken to the operating room for a robotic left radical adrenalectomy with renal vein tumor thrombectomy. Intraoperative ultrasound was used to delineate the extent of tumor thrombus into the left renal vein. The left renal artery, proximal and distal aspect of left renal vein and left gonadal vein were briefly controlled with vascular clamps. The adrenal vein was incised close to the renal vein and the tumor thrombus was removed en bloc with the left radical adrenalectomy specimen. The venotomy was repaired using 4-0 Prolene and the kidney was revascularized.
Renal warm ischemia time was 26 minutes, estimated blood loss was 800cc, operative time was 4.4 hours. Pathology revealed a 6.5cm pheochromocytoma with vein tumor thrombus. Surgical and vein margins were negative. Intra-operatively there were no uncontrolled or sustained hypertensive episodes.
Robotic assisted radical adrenalectomy is a feasible option for patients with associated adrenal or renal vein tumor thrombus without compromising oncologic outcome. Fundamental technical steps include use of intraoperative ultrasound, renal vascular control and renal venotomy repair.