Abstract
BackgroundTo explore the feasibility of single-position laparoscopic radical nephrectomy (LRN) and tumor thrombectomy for left renal cell carcinoma with high-risk Mayo 0 and 1 tumor thrombus (TT).MethodsAll patients with left renal cell carcinoma and venous TT (high-risk Mayo grade 0 and 1) who were performed single-position LRN and tumor thrombectomy were involved. After the renal artery was controlled by Hem-o-lok, the left renal vein was dissected through descending colon mesentery. The left renal vein was divided by EndoGIA for high-risk Mayo grade 0 TT. For Mayo grade 1 TT, part of the inferior vena cava was blocked by a bulldog clamp after milking the TT into the left renal vein and the inferior vena cava was sutured after complete excision of the TT.Results3 patients were involved and operations were performed successfully without conversion to open surgery. The mean operation time was 136 min and the mean estimated blood loss was 60 mL. No postoperative complications occurred.ConclusionsIt is feasible to control left renal vein and partial inferior vena cava through descending colon mesentery in a single position during LRN and tumor thrombectomy for the treatment of high-risk Mayo grade 0 and 1 TT.
Highlights
Invasion of the venous system is one of the clinical features of locally advanced kidney cancer
Mayo grade 0 tumor thrombus (TT), the end of the TT is on the left side of the mesenteric artery, the left renal vein can be fully controlled by traditional approach
In order to simplify the procedure, we explored the trans-mesocolon approach to fully dissect the left renal vein to the inferior vena cava in single position to treat high-risk Mayo 0-grade and grade 1 TT
Summary
Invasion of the venous system is one of the clinical features of locally advanced kidney cancer. Mayo grade 0 TT, the end of the TT is on the left side of the mesenteric artery, the left renal vein can be fully controlled by traditional approach If it is a high-risk Mayo grade 0 TT or even grade 1 TT, traditionally two steps were utilized including management of the inferior vena cava and removement of the TT, and nephrectomy after changing the surgical position. The aim of the study was to explore the feasibility of single position transperitoneal laparoscopic radical nephrectomy (LRN) and high-risk Mayo 0 and 1 tumor thrombectomy and the surgical techniques were described in detail. To explore the feasibility of single-position laparoscopic radical nephrectomy (LRN) and tumor thrombectomy for left renal cell carcinoma with high-risk Mayo 0 and 1 tumor thrombus (TT)
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