Nicolae Crisan1,2, Iulia Andras1,2, Doru-Lucian Grad2, Teodora Telecan1, Radu-Tudor Coman3, Ottavio de Cobelli4, Deliu Victor Matei1,4, Ioan Coman1,2. 1. 1 Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania . 2. 2 Urology Department, Clinical Municipal Hospital , Cluj-Napoca, Romania . 3. 3 Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania . 4. 4 Urology Division, European Institute of Oncology , Milan, Italy .
Abstract
OBJECTIVE: To present our technique and initial results of dual combined retroperitoneal and transperitoneal laparoscopic approach for the treatment of renal-cell carcinoma (RCC) with level 0-II venous tumor thrombus. PATIENTS AND METHODS: We included nine consecutive patients with RCC and level 0-II inferior vena cava (IVC) thrombus who underwent laparoscopic radical nephrectomy and IVC thrombectomy using dual combined laparoscopic approach in our department between January 2016 and June 2017. RESULTS: The mean operative time was 150 minutes when cavotomy was not performed and 240 minutes when cavotomy with thrombectomy was required. The mean IVC clamping time was 24 minutes and the mean blood loss was 300 mL. We encountered no major intraoperative or postoperative complications (Clavien III-IV). The patients were discharged a mean of 7 days after the procedure. At the 6-month follow-up, all patients were alive. One patient presented a retroperitoneal enlarged lymph node and started systemic treatment. CONCLUSIONS: The dual combined laparoscopic approach for kidney tumors with level 0-II IVC thrombus is feasible, reproducible, and especially useful in patients with complex renal pedicle. The technique provides early arterial control by retroperitoneal approach, which reduces the blood flow through the renal vein and has the advantage of minimal mobilization of the thrombus-bearing renal vein; it therefore lowers the risk of tumor embolism and intraoperative hemorrhage.
OBJECTIVE: To present our technique and initial results of dual combined retroperitoneal and transperitoneal laparoscopic approach for the treatment of renal-cell carcinoma (RCC) with level 0-II venous tumor thrombus. PATIENTS AND METHODS: We included nine consecutive patients with RCC and level 0-II inferior vena cava (IVC) thrombus who underwent laparoscopic radical nephrectomy and IVC thrombectomy using dual combined laparoscopic approach in our department between January 2016 and June 2017. RESULTS: The mean operative time was 150 minutes when cavotomy was not performed and 240 minutes when cavotomy with thrombectomy was required. The mean IVC clamping time was 24 minutes and the mean blood loss was 300 mL. We encountered no major intraoperative or postoperative complications (Clavien III-IV). The patients were discharged a mean of 7 days after the procedure. At the 6-month follow-up, all patients were alive. One patient presented a retroperitoneal enlarged lymph node and started systemic treatment. CONCLUSIONS: The dual combined laparoscopic approach for kidney tumors with level 0-II IVC thrombus is feasible, reproducible, and especially useful in patients with complex renal pedicle. The technique provides early arterial control by retroperitoneal approach, which reduces the blood flow through the renal vein and has the advantage of minimal mobilization of the thrombus-bearing renal vein; it therefore lowers the risk of tumor embolism and intraoperative hemorrhage.
Authors: Iulia Andras; Angelo Territo; Teodora Telecan; Paul Medan; Ion Perciuleac; Alexandru Berindean; Dan V Stanca; Maximilian Buzoianu; Ioan Coman; Nicolae Crisan Journal: J Clin Med Date: 2021-04-21 Impact factor: 4.241