Nephrectomy, work bench surgery, and autotransplantation: a case of a solitary left kidney with an extensive centrally located renal cell carcinoma and a tumour thrombus entering the vena cava.

OBJECTIVES: In patients with imperative indication, organ preserving kidney tumour surgery is state of the art. We present our management of an extensive centrally located renal cell carcinoma.
METHODS: The patient was suffering from a 8x6x6cm centrally located tumour in the solitary left kidney which infiltrated the lower pole of the kidney, the hilum and built a large tumour thrombus entering the vena cava inferior. We performed a radical nephrectomy with cavotomy, tumour trombectomy and tumour resection in cold ischemia at the work bench (R0).
RESULTS: Total ischemic time took 4 h, warm ischemic time 60 min. The pathological tumour stage was pT3b, pN0, R0. During 17 mo of aftercare, the patient was free of metastatic disease and without complaints (serum creatinine actually 1.6 mg/dl).
CONCLUSIONS: Hemodialysis reduces the quality of life for 30-40%, the mean mortality rate on hemodialysis is 13% per patient year. To prevend patients from hemodialysis, nephrectomy, work bench surgery and autotransplantation, even in large centrally located tumours and multimorbid patients should be considered to maintain quality and to extend expectancy of life.