Clinical analysis of pure laparoscopic surgery for renal cell carcinoma with inferior vena cava tumor thrombus

Abstract

Objective To assess the safety and feasibility of pure laparoscopic surgery for renal cell carcinoma with inferior vena cava tumor thrombus. Methods We retrospectively analyzed 6 cases of renal cell carcinoma with inferior vena cava tumor thrombus from December 2010 to October 2014. The patients were all male.Their age ranged from 50 to 69 years and the body mass index ranged from 21.6 to 30.9 kg/m2. Clinical manifestations included painless hematuria in 4 cases, low back pain in 1 cases and physical examination noticing in 1 cases. Imaging suggested the right renal tumor in 4 cases and left renal tumor in 2 cases. The tumor size ranged from 4.0 to 10.6 cm.The inferior vena cava tumor thrombus was found in all patients, including type Ⅰ thrombus in 3 cases and type Ⅱ thrombus in 3 cases. The length of type Ⅱ tumor thrombus ranged from 4.0 to 4.2 cm. We completed pure laparoscopic nephrectomy and inferior vena cava tumor thrombectomy in all patients. We chose retroperitoneal laparoscopic surgery to treat right renal tumor with inferior vena cava thrombus and chose retroperitoneal combined with transperitoneal laparoscopic surgery to treat left renal tumor with inferior vena cava thrombus. Results All surgery were successful. Cancer embolus defluxion didn't occur during the opearation. The operation time was 224–873 min and the intraoperative blood loss was 200–5 000 ml. There were 4 patients get transfusion, which the transfusion volume ranged from 400 to 2 800 ml. For 1 case of left renal cell carcinoma with level Ⅱ inferior vena cava tumor, the operation time was 873 min, the blood loss was 5 000 ml, and the transfusion volume was 2 800 ml. Postoperative hospital stay was 7–14 days. And the pathological results were all renal clear cell carcinoma. In those patients, the Fuhrman grade classification was Ⅱ–Ⅲ. All patients were treated by targeted medicine to control tumor recurrence and metastasis. During the 6–48 months following up, no recurrence and metastasis were reported. Conclusions Pure laparoscopic surgery for right renal cell carcinoma with inferior vena cava tumor thrombus and left renal cell carcinoma with level Ⅰ inferior vena cava tumor thrombus is safe and feasible. However, long learning curve should be necessary for performing the left renal cell carcinoma with level Ⅱ inferior vena cava tumor thrombus. The effect of total laparoscopic surgery for renal cell carcinoma with inferior vena cava tumor thrombus is definite. Key words: Carcinoma, renal cell; Inferior vena cava tumor thrombus; Laparoscopic surgery