V3-06: Conventional Laparoscopic Radical Nephrectomy with inferior vena cava thrombectomy
In the past decade, the options of targeted therapy agents, for the treatment of advanced and metastatic renal cell carcinoma (RCC) has significantly increased. This increase has lead to a migration of targeted therapy agents from salvage to the neoadjuvant setting for large unresectable masses, venous tumor thrombus involvement, and patients with imperative indications for nephron sparing._x000D_ Venous tumor thrombus involvement of Inferior vena cava (IVC) is a complicating factor that occurs in up to 10% of cases of patients with renal cell carcinoma (RCC), of which nearly one-third of patients also have concurrent metastatic disease. The surgical management with laparoscopic technique for renal cell carcinoma with IVC tumor thrombus remains challenging and technically demanding in urological oncology. Our objective is to describe the surgical technique of a right pure conventional laparoscopic Radical Nephrectomy with (IVC) thrombectomy in a patient with level II thrombus who receive neoadjuvant target therapy.
A 78-year-old male with lung metastatic renal cell carcinoma cT3bN1M1, received target therapy in neoadjuvant setting and after improving in the Memorial Sloan-Kettering Cancer Center Score for Metastatic Renal Cell Carcinoma (MSKCC/Motzer) and International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic scores, underwent cytoreductive nephrectomy with thrombectomy of IVC._x000D_ We report one case of right pure conventional laparoscopic radical nephrectomy and thrombectomy of the level II (infrahepatic) tumor thrombus in the IVC._x000D_ To do this, IVC was isolated, the right gonadal and lumbar veins were ligated and transected. The infrarenal IVC, left renal vein and infrahepatic IVC blood flow were controlled with a bulldog clamp. After thrombectomy of the IVC, the wall defect was sutured with continuous Prolene suture and then a laparoscopic radical nephrectomy was performed._x000D_
The operative time was 300 min and the IVC clamping time was 15min. The estimated blood loss was 700 ml, and no major intraoperative or postoperative complications occurred. The patient was discharged from hospital 3 days after the surgery without needing critical care unit.
Laparoscopic radical nephrectomy with thrombectomy for renal cell carcinoma with tumor thrombus level II is a safe, reproducible and technically feasible technique, which can be applied to a specific population of patients but also is challenging and requires advanced laparoscopic skills.