V01-12 ROBOTIC SUPRARENAL CAVECTOMY IN A PATIENT WITH KIDNEY TUMOR AND LEVEL III TUMOR THROMBOSIS

Abstract

You have accessJournal of UrologyKidney Cancer I: Partial Nephrectomy & Kidney Preservation Strategies (V01)1 Apr 2020V01-12 ROBOTIC SUPRARENAL CAVECTOMY IN A PATIENT WITH KIDNEY TUMOR AND LEVEL III TUMOR THROMBOSIS Luis G Medina*, Alireza Ghoreifi, Hatim Thaker, Vinay Duddalwar, and Hooman Djaladat Luis G Medina*Luis G Medina* More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Hatim ThakerHatim Thaker More articles by this author , Vinay DuddalwarVinay Duddalwar More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000826.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Inferior vena cava (IVC) thrombosis occurs in less than 10% of patients with renal cell carcinoma (RCC). Up to 25% of these cases will require IVC interruption or resection, yet caval replacement is controversial. Our aim is to present the first reported case of robotic suprarenal cavectomy without reconstruction in a patient with RCC. METHODS: A 50-year-old male was found to have 9-cm right renal mass and level III thrombosis during his workup for pulmonary embolism. The length of IVC thrombus was 112 mm, terminating 3.6 cm below the level of hepatic veins and occluded 100% of the IVC without distal bland thrombosis. CT scan showed suspicious lesion in liver and contralateral adrenal, though supplementary imaging ruled out liver metastasis. He underwent robotic right radical nephrectomy, retroperitoneal lymph node dissection, IVC thrombectomy, and suprarenal cavectomy, using 6-port da Vinci Xi surgical system. Intraoperative ultrasound and Trans-Esophageal Echocardiography were employed to ensure the proper IVC controls and endo-GIA was used for cavectomy. RESULTS: The surgery was completed successfully without intraoperative complication. Operating time was 6 hours and estimated blood loss was 300 cc. Intraoperative ultrasound showed the tip of the thrombus and helped to secure rommel control just above it. After securing/cinching down all controls, IVC was opened and thrombus was removed. Cavectomy was deemed necessary due to multiple areas of tumor adhesions to inner part of IVC. Nephrectomy was completed and all specimens removed through pfannstiel incision. Postoperative course was uneventful and discharged home in 4 days. Baseline GFR was 44 and at discharge was 49 mL/min/1.73m2. Pathology endorsed clear cell RCC (pT3bN0) with negative margins as well as multiple adherent tumors in middle section of IVC (non-invasive). No complication including lower limb edema was reported within 90-day, postoperatively. He is without evidence of disease (NED), 9-month after surgery. CONCLUSIONS: Herein, we are reporting a case of right RCC with level III IVC thrombosis that underwent robotic right radical nephrectomy and suprarenal cavectomy, due to possible infiltration of tumor thrombosis to IVC wall. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e93-e94 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luis G Medina* More articles by this author Alireza Ghoreifi More articles by this author Hatim Thaker More articles by this author Vinay Duddalwar More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement PDF downloadLoading ...