V5-12: Laparoscopic Resection of Retroperitoneal Recurrence of Renal Carcinoma
Nephrectomy is the treatment of choice for localised renal cell carcinoma. Local isolated recurrence is rare, occurring in 2% of patients after radical nephrectomy. Surgical exeresis of the local recurrence in the absence of metastatic disease is a viable treatment, with local control of the tumour and improved survival.
We present the case of a 76-year-old man who in 2010 underwent left radical nephrectomy by retroperitoneoscopy, with pathological results indicating a type 2 papillary renal carcinoma (Fuhrman II, pT1a) with negative margins. After 5 disease-free years and based on an abdominal pain study (CT and MRI), a retroperitoneal mass measuring 62 x 58 mm was observed in the left nephrectomy fossa. The diagnostic puncture revealed renal carcinoma. The decision was made to perform laparoscopic exeresis of the tumour recurrence.
A transperitoneal approach was performed with an optical trocar and 3 additional trocars. We performed para-aortic dissection from the suprarenal area to the aortic bifurcation. We then performed an adrenalectomy and exeresis of the tumour mass, with iterative clipping of the renal vessels and a safety suture in the left renal artery. The main complexity lies in accessing the mass, while its exeresis is usually easier. The surgical time was 240 minutes, with a blood loss of 350 cc. There were no complications. The patient was discharged on the fourth day after surgery. Pathology showed metastasis of papillary renal carcinoma type 2 (Fuhrman II), with tumour-free margins._x000D_ Between 2009-2015, we performed 8 laparoscopic exeresis of local recurrences of renal carcinoma, with a mean patient age of 64.7 years. The average disease-free time to recurrence was 26.8 months. The average surgical time was 202.5 min. Pathology confirmed renal cell carcinomas in all cases with negative margins. The average hospital stay was 5.2 days, with a low rate of complications. Two patients required transfusions (Clavien II), and pleural drainage was placed in one patient (Clavien IIIa). The only death was at 3.5 years.
The laparoscopic approach for the retroperitoneal recurrence of renal tumours is a feasible treatment that helps treat simple cases with low morbidity and is potentially curative in selected cases.