Background and Purpose: Renal-vein tumor thrombus associated with renal malignancy has traditionally been approached with open surgery, and preoperative diagnosis of stage T3b renal tumors often mandates open surgery. However, early arterial division and “milking” of the thrombus away from the inferior vena cava may facilitate laparoscopic surgery. We describe our single-surgeon experience with laparoscopic nephrectomy in patients with tumor extension into the renal vein.
Patients and Methods: Among 240 laparoscopic nephrectomies performed by a single surgeon from 2002 to 2005, six patients (2.6%) were found to have renal-vein tumor thrombus. These patients included three men and three women with a mean age of 55.8 years (range 43–78 years). Data collected prospectively were evaluated to characterize this cohort.
Results: All six tumors were right-sided, stage T3b, and all were managed laparoscopically without major complications. Three tumors were suspected to have renal-vein thrombus on preoperative imaging; the other three tumor thrombi were discovered on pathologic examination. The mean tumor size was 9.5 cm (range 7.5–11.5 cm). Two tumors were grade 2, three were grade 3, and one patient had a grade 4 rhabdoid cell-type tumor. At a mean follow-up of 27 months, all patients were without evidence of disease with the exception of the patient with grade 4 disease, who developed recurrence in the chest.
Conclusion: Laparoscopic nephrectomy for tumor with renal-vein thrombus can be accomplished safely with adherence to proper oncologic techniques.
