Geoffrey H Rosen1, Paige A Hargis2, Christopher Cunningham3, Naveen Pokala1. 1. Division of Urology, Department of Surgery, University of Missouri, Columbia, Missouri, USA. 2. School of Medicine, University of Missouri, Columbia, Missouri, USA. 3. Department of Pathology, University of Missouri, Columbia, Missouri, USA.
Abstract
Background: Renal cell carcinoma (RCC) recurrence can present in nearly any location. Rarely, recurrence is within the venous system. Previous reports of such recurrent tumor thrombectomy have all used an open approach. For the first time, we present robotic excision of recurrent RCC tumor thrombus. Case Presentation: This is a 59-year-old man who was referred to us 3 years after right robotic radical nephrectomy and renal vein tumor thrombectomy with positive margins. He had been lost to follow-up after 1 year. He presented again 3 years after surgery and was found to have recurrence with inferior vena cava (IVC) tumor thrombus to the caudal margin of the liver. He was taken for robotic tumor thrombectomy, which was completed with 900 mL of estimated blood loss, requiring a single unit of packed red blood cells. The surgery was complicated by increased bleeding caused by an undiagnosed arteriovenous fistula between the right renal artery and vein remnants. Conclusion: Robotic excision of recurrent RCC IVC thrombus is a potential treatment for selected patients under the care of experienced robotic surgeons. Copyright 2020, Mary Ann Liebert, Inc., publishers.
Background: Renal cell carcinoma (RCC) recurrence can present in nearly any location. Rarely, recurrence is within the venous system. Previous reports of such recurrent tumor thrombectomy have all used an open approach. For the first time, we present robotic excision of recurrent RCC tumor thrombus. Case Presentation: This is a 59-year-old man who was referred to us 3 years after right robotic radical nephrectomy and renal vein tumor thrombectomy with positive margins. He had been lost to follow-up after 1 year. He presented again 3 years after surgery and was found to have recurrence with inferior vena cava (IVC) tumor thrombus to the caudal margin of the liver. He was taken for robotic tumor thrombectomy, which was completed with 900 mL of estimated blood loss, requiring a single unit of packed red blood cells. The surgery was complicated by increased bleeding caused by an undiagnosed arteriovenous fistula between the right renal artery and vein remnants. Conclusion: Robotic excision of recurrent RCC IVC thrombus is a potential treatment for selected patients under the care of experienced robotic surgeons. Copyright 2020, Mary Ann Liebert, Inc., publishers.
Authors: William P Parker; Stephen A Boorjian; Harras B Zaid; John C Cheville; Bradley C Leibovich; R Houston Thompson Journal: Eur Urol Focus Date: 2016-07-07