V406: Robotic Partial Nephrectomy for Renal Cell Carcinomas with Venous Tumor Thrombus
VideoIntroduction and Objectives
Renal cell carcinoma (RCC) has a predilection for extension into veins, which can prevent the ability to perform partial nephrectomy when otherwise possible. Partial nephrectomy with venous tumor thrombus is feasible when venous drainage of the remaining kidney is preserved and negative surgical margins can be achieved. We present two first such reports of robotic partial nephrectomy (RPN) in the setting of venous extension of RCC, including one with extension into a vein branch within the parenchyma and a second case extending into the main renal vein.
One 4.3cm tumor was found to have extension into a branch of the renal vein on intraoperative ultrasound. The mass was excised with the vein and tumor thrombus as one unit, following the vein into the parenchyma until the end of the tumor thrombus was found. Another patient undergoing heminephrectomy for a 9.3cm RCC had extension from one of two major branches into the main renal vein. The tumor and associated branch were excised as one unit, extracting the tumor thrombus from the main renal vein with suture reconstruction for drainage of the remaining half of the kidney.
Both were performed with less than 30min of warm ischemia time. Both patients were discharged on the first postoperative day without complications and with negative surgical margins.
RPN can be successfully performed for selected tumors with venous tumor thrombus. While local control can likely be achieved as well as nephrectomy, systemic recurrence remains the greater threat in such T3a patients.