RETROPERITONEOSCOPIC RADICAL NEPHRECTOMY WITH INFERIOR VENA CAVA THROMBECTOMY

Introduction. Although laparoscopic radical nephrectomy has confidently established itself as the «gold standard» for treating renal cell carcinoma, reports on laparoscopic level II-III inferior vena cava (IVC) tumor thrombus thrombectomy are still lacking. Materials and methods From September 2013 through April 2015, three patients with renal cell carcinoma and level II IVC tumor thrombi underwent laparoscopic radical nephrectomy with IVC thrombectomy using a retroperitoneal approach. Tumor sized 10, 8, and 9 cm in the greatest dimension, the length of the IVC thrombi in proximal direction were 2.8, 4.1 and 3.5 cm, respectively. Results In all patients, the endoscopic interventions were completed successfully without conversion to open surgery. Blood loss was less than 450 ml. No significant intraoperative or postoperative complications were observed. The patients were discharged from the hospital in satisfactory condition at days 19, 7 and 14, respectively. One patient with multiple lung and bone metastases died 11 months after the operation. The two other patients showed no signs of disease progression during the follow-up (16 and 35 months). Conclusion The retroperitoneal approach has certain advantages over the transperitoneal one. The method is relatively safe and reproducible. However, additional experience and further research are needed before the place of such operations in routine clinical practice can be assessed.

kidney cancer T3b, tumor thrombus IVC, retroperitoneoscopic thrombectomy