Pure laparoscopic radical nephrectomy with level II vena caval thrombectomy

Romero, Frederico R.; Müntener, Michael; Bagga, Herman S.; Brito, Fábio Augusto R.; Sulman, Aaron; Jarrett, Thomas W.

doi:10.1016/j.urology.2006.08.1084

Cited by 72 publications

(31 citation statements)

References 14 publications

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“…In light of these developments, it is not surprising that one group reported on a pure LRN with level II vena caval thrombectomy [9 ]. After ligating the artery, the authors used a laparoscopic Satinsky clamp to occlude the IVC segment containing the thrombus, which extended 3 cm above the renal vein: level II has been defined as tumor of more than 2 cm above the renal vein but limited to the infrahepatic IVC [26].…”

Section: Expanding Indicationsmentioning

confidence: 99%

Laparoscopic radical nephrectomy: long-term outcomes

Borin

2008

Current Opinion in Urology

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Section: Expanding Indicationsmentioning

confidence: 99%

Laparoscopic radical nephrectomy: long-term outcomes

Borin

2008

Current Opinion in Urology

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“…In this procedure, the tumor thrombus was "milked back" into the renal vein so as to block the vein with vascular clips or an endoscopic stapling device (13). Before Romero et al (6) reported the first case of pure LRN with level II tumor thrombectomy, Fergany et al (14) successfully performed laparoscopic radical nephrectomy with level II thrombectomy in a survival porcine model, which showed clinical application of this technique appeared possible. The report of conventional pure LRN with level II tumor thrombectomy was very rare.…”

Section: Discussionmentioning

confidence: 99%

“…One case of renal tumor with IVTT extended 3cm above the renal vein (level II tumor thrombus) managed with pure LRN with tumor thrombectomy was reported in 2006 (6). To the best of our knowledge, only limited data are available in English literature with regard to pure LRN with level II IVC tumor thrombectomy and no report of more extensive tumor thrombus treated with pure LRN has been described up to now.…”

Section: Introductionmentioning

confidence: 99%

Pure Conventional Laparoscopic Radical Nephrectomy with Level II Vena Cava Tumor Thrombectomy

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________The surgical management with laparoscopic technique for renal cell carcinoma with inferior vena cava tumor thrombus (IVTT) remains challenging and technically demanding in urological oncology. We present two patients with level II IVTT that were managed with pure conventional laparoscopic radical nephrectomy and thrombectomy. Two patients were diagnosed with a renal tumor with level II IVTT from December 2011 to January 2012. They both underwent pure conventional laparoscopic radical nephrectomy with thrombectomy. During these operations, intraoperative laparoscopic ultrasonography was used to detect the thrombus and ensure complete removal. Two patients were operated through retroperitoneal approach for right renal tumor and transperitoneal approach for left renal tumor respectively. The demographics, perioperative and follow-up data were recorded for the study. Both operations were successfully performed without conversion. They both had no radiographic evidence of recurrence during follow-up. It is concluded that it is feasible to manage renal cell carcinoma with level II IVTT through pure conventional laparoscopic approach in carefully selected patients, which might expand the indication for laparoscopic surgery. The pure laparoscopic approach in the treatment of renal cell carcinoma with level II vena cava tumor thrombus is challenging and requires advanced laparoscopic skills. Multicenter prospective randomized control trials are needed to prove the benefits of this approach.

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“…Some have questioned its benefits [28][29][30][31] while others have used laparoscopy for IVC tumor thrombi using open incisions for tumor thrombectomy after laparoscopic mobilization and dissection [32][33][34] or pure laparoscopy with hand assistance for the thrombectomy only [35]. Single case reports have also been described using hand-assisted or pure laparoscopy for short thrombi [36,37], recently few case reports and one case series of robotic IVC thrombectomy has been reported in the literature [38].We await results of larger series since robotic and laparoscopic IVC tumor thrombectomy remain a challenging procedure and should not be embarked on lightly and hence open surgery remains the predominant method for addressing RCC involving the IVC.…”

Section: Minimal Invasive Techniquesmentioning

confidence: 99%

“…Since our series expands nearly two decades the complication were higher in earlier period. Minimal invasive techniques are being propagated as an effective alternative in reducing morbidity [32][33][34][35][36][37][38].…”

Section: Mortality and Morbiditymentioning

confidence: 99%

IVC Thrombectomy in Renal Cell Carcinoma—Analysis of Out Come Data of 100 Patients and Review of Literature

Kulkarni

Jadhav

Valsangkar

2011

Indian J Surg Oncol

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To review our experience of RCC with IVC thrombus in terms of clinical presentation, principles of surgical management in contemporary era, also an impact of clinico-pathological factors on prognosis. Total 100 patients who underwent radical nephrectomy and IVC thrombectomy between 1991-2008 were included in this retrospective analysis. Data was analysed in terms of clinical pathological factors, survivals and compared with contemporary literature. The extent tumour thrombus was infrahepatic in 58 retro hepatic in 28 and suprahepatic in 14 patients including 6 with right atrial thrombus. The immediate postoperative mortality was 2% and incidence of major postoperative non fatal complications was 38%, which were managed conservatively. The overall and disease free 5 year survival was 63% and 55%. Further amongst the histological types, patients with clear cell tumours had the best (DFS-71.42%), and those with papillary had the poor (DFS-30.76%) outcome. Grade II tumors had better survivals as compared to grade IV (DFS 75.39% vs 23.52%, p<0.05). Loco-regional extent wise 74% patients without perinephric fat invasion were free from disease at 5 years as compared to 30% of those who had perinephric fat invasion (p<0.01). Similarly 5 year DFS was 76.11% in patients with negative nodes as compared to 12% in positive nodes (p<0.01). In conclusion radical nephrectomy with IVC thrombectomy still remains the most effective therapeutic option in management in this clinical setting. Although this is complicated surgery success with multi disciplinary approach excellent survival outcome can be obtained. Further pathological factors, such as locoregional spread and grade of tumor, rather than clinical factors influence long term survival.

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Pure laparoscopic radical nephrectomy with level II vena caval thrombectomy

Cited by 72 publications

References 14 publications

Laparoscopic radical nephrectomy: long-term outcomes

Laparoscopic radical nephrectomy: long-term outcomes

Pure Conventional Laparoscopic Radical Nephrectomy with Level II Vena Cava Tumor Thrombectomy

IVC Thrombectomy in Renal Cell Carcinoma—Analysis of Out Come Data of 100 Patients and Review of Literature

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