Laparoscopic management renal cell carcinoma in left kidney with tumor caval thrombus

Background.Treatment of level II-III inferior vena cava (IVC) tumor thrombus for left renal cell carcinoma is among the most challenging open urologic oncologic surgeries with 38 % complications and 4—10 % mortality rate. There are increasing numbers of centers using a right side laparoscopic radical nephrectomy with thrombectomy at last years but only few reports about laparoscopic management of IVC thrombus from left kidney.

The study objectiveis to demonstrate reproducibility and relative safety of laparoscopic radical nephrectomy with thrombectomy of IVC tumor thrombus originating from the left kidney.

Materials and methods. We describe the method and present the initial series of full laparoscopic level II-III IVC thrombectomy in three patients with tumor in left kidney. One patient had been diagnosed distant metastases before operation, the another — pancreas involvement in the tumor process. The follow up time consist 4—26 months after surgery.

Results. All procedures completed without conversion to open surgery. Tumor sizes were 5—16 cm, length of thrombus in IVC — 2.4—7.0 cm. Volume of blood loss ranged from 300 to 2500 ml. One patient received blood transfusion after surgery. One patient have died because of distant metastases 5 months after surgery. Two others were alive at 4 and 26 months follow-up without signs of progression.

Conclusion.Laparoscopic IVC tumor thrombectomy for level II-III thrombi in cases of left kidney cancer is feasible, safe. This kind of pro­cedure doesn’t lead to serious perioperative complications and can gain a quicker recovery after surgery. It needs more operations and longer follow-up for evaluation oncological efficiency.

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