AUA 2006 - ABST [1689] Laparoscopic Management of Advanced Renal Cell Carcinoma with Level I Renal Vein Thrombus

Anil Kapoor, Hamilton, ONCanada; Christopher Nguan*, London, ONCanada; Tariq Al-Shaiji, Abdullatif Hussein, Hamilton, ONCanada; Luke Fazio, Mohammed Al Omar, Patrick Luke, London, ON, Canada.

Introduction and Objective: The existence of renal vein tumor thrombus presents a technical challenge in securing hilar control during the resection of the renal mass. We present our series of laparoscopic radical nephrectomy in patients with level I tumor thrombus. To our knowledge, this experience represents one of the largest series of laparoscopic nephrectomy for renal cell carcinoma with renal vein thrombus.

Methods: Between April 2002 and June 2004, 12 patients ( 8 M : 4 F ) with the mean age of 62.7 years were diagnosed with renal cell carcinomas. Tumors were left sided in 7 cases, and right sided in 5 cases. In addition to computerized tomography (CT), venacavography and magnetic resonance imaging was utilized to determine the levels of tumor thrombi pre-operatively in those who had suspicious involvement of the renal vein on the CT scan.

Results: Laparoscopic nephrectomy was performed in a standard fashion. Hand-assisted laparoscopic nephrectomy was used in 6 cases involving large tumors with bulky hilar adenopathy. All renal veins were stapled using an endoscopic vascular stapler. Intra-operative laparoscopic ultrasound was used to delineate the extent of the vein thrombus in 6 cases to enable proper stapler positioning. There were no intra-operative complications and 2 cases were electively converted to open nephrectomy. Post-operative narcotic requirements and hospitalization times were low. Pathologic examination of the tumor specimens demonstrated negative resection margins in all patients.

Conclusions: In carefully selected patients, laparoscopic resection of renal masses with level I renal vein thrombi is feasible. Due to technical considerations that may be identified intraoperatively, early conversion to open nephrectomy needs to be anticipated. Long-term results regarding oncologic control continue to be assessed.
Wednesday, Wednesday, May 24, 2006 3:30 PM
Moderated Poster: Renal Transplantation: Renal Vascular Surgery (II) (3:30 PM-5:30 PM)

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