V10-07: Laparoscopic Management of Locally Advanced Kidney Tumor: Left Nephrectomy with Distal Spleno-pancreatectomy
Complete tumor debulking in kidney cancer is the main principle to achieve better oncological results. Radical nephrectomy is the treatment of choice for locally advanced kidney tumor. However, the laparoscopic approach of locally advanced kidney tumor remains a surgical challenge , especially for high tumor volume and involvement of nearby organs.
In this video we describe step by step a left radical nephrectomy with en bloc splenectomy and distal pancreatectomy for a non-metastasic advanced kidney tumor with pancreatic tail invasion.
The patient is diagnosed of a 15cm kidney tumor with signs of invasion of the pancreatic tail. Large tumor volume hinders the hilum vascular control. Access to the lesser sac permits the dissection of the splenic vessels. Pancreatic tail is sectioned by an endo-stappler. Gastrosplenic ligament is sectioned and the left kidney is mobilized, allowing en bloc resection of the left kidney, adrenal gland, pancreatic tail and the spleen.
The laparoscopic approach for large kidney tumor volume with local invasion is a feasible option in high volume centers. Further studies are needed to assess its impact on surgical morbidity and oncological outcomes. The main aim is to allow reducing surgical morbidity with the primacy of not jeopardizing the oncologic outcomes.