CU 39. Retroperitoneal laparoscopic - assisted radical nephrectomy for huge renal cell carcinoma with level II vena caval thrombus (attaching 7 cases report and surgery film)

Objective: Retroperitoneal laparoscopic-assisted radical nephrectomy (RLARN) is utilized to treat huge renal cell carcinoma with Level II vena caval thrombus in selected patients. We reported experiences of 7cases in this approach and reviewed its safety and feasibility.

Methods: We retrospective studied 7 cases with RLARN from Oct. 2010 to Dec. 2011 in our center. The clinical stage, preoperative imaging, intraoperative parameters, final pathology, and postoperative courses of these 7 cases were analyzed.

Results: The average max radius of tumors with RLARN in contrast MRI was 10.6±5.4 cm, all thrombus were II level (Neves' Grade). The surgeon anatomized the kidney and blocked renal artery in retroperitoneal laparoscopic approach. And the thrombus was extracted through a cavotomy under direct vision. The average operation time was 266±78.3 min, blood loss was 117±41.5 mL, length of caval thrombus was 3.0±1.2 cm. Patients were discharged on day 5-7.

Conclusions: RLARN is safety and feasibility to treat huge renal cell carcinoma with Level II vena caval thrombus in selected patients. The blood loss and risk of blood vessels injury in this approach were much less than traditional open approach.