Laparoscopic Management of Advanced Renal Cell Carcinoma with Renal Vein and Inferior Vena Cava Thrombus
CUA Online Library. Bansal R. 06/24/13; 31267; MP-03.10
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Abstract
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Laparoscopic Management of Advanced Renal Cell Carcinoma with Renal Vein and Inferior Vena Cava Thrombus.
Rahul Bansal, Anil Kapoor, Bobby Shayegan, J Paul Whelan and Darrel Drachenberg
Abstract
Introduction & Objectives
The traditional open surgical method of resection of renal mass with removal of venous thrombus has paved the way for laparoscopic radical nephrectomy (LRN) and venous thrombectomy in multiple case reports and case series. The goal of this study is to report the results and oncological efficacy of LRN in patients of renal cell carcinoma (RCC) with renal vein (RV) and inferior vena cava (IVC) thrombus.
Patients and Methods
We performed retrospective chart review of 44 patients who underwent laparoscopic radical nephrectomy along with venous thrombectomy from two centers in Canada from 2002 to 2012 by dedicated laparoscopic surgeons. Technique of laparoscopic radical nephrectomy and caval thrombectomy in this series will be described.
Results
The mean age and body mass index of the 44 study patients (M:F = 35:9) were 64.7years and 29.1kg/m2 respectively. Median tumor size was 8.9cm, 42 patients had RV thrombus and 2 had IVC thrombus. Seven (16%) patients had undergone previous abdominal surgeries. Nine patients (20.5%) had metastatic disease to begin with and underwent laparoscopic cytoreductive nephrectomy. Median estimated blood loss, operative time and length of stay were 100mL (range 50-400), 134.5 minutes (range 99-183) and 4 days (range 4-6) respectively. There were 2 (4.6%) intra-operative and 5 (11.6%) peri-operative complications. Three (7%) patients required blood transfusions peri-operatively. There was no intra-operative death. Mean duration of follow-up was 42 months (range 6-107). Eight (18%) patients died due to progressive disease and 3 (7%) patients died due to unrelated causes. Twenty nine (66%) patients were alive at the end of follow-up period. Out of these 21 (48%) were disease free and 8 (18%) had local or systemic disease progression. Three patients lost to follow-up.
Conclusion
Laparoscopic radical nephrectomy and venous thrombectomy for advanced renal tumors with venous thrombus is a safe procedure in experienced hands with significant laparoscopic skills. The short-term oncological data is encouraging and advocates the efficacy of this procedure in this subset of patients.
Rahul Bansal, Anil Kapoor, Bobby Shayegan, J Paul Whelan and Darrel Drachenberg
Abstract
Introduction & Objectives
The traditional open surgical method of resection of renal mass with removal of venous thrombus has paved the way for laparoscopic radical nephrectomy (LRN) and venous thrombectomy in multiple case reports and case series. The goal of this study is to report the results and oncological efficacy of LRN in patients of renal cell carcinoma (RCC) with renal vein (RV) and inferior vena cava (IVC) thrombus.
Patients and Methods
We performed retrospective chart review of 44 patients who underwent laparoscopic radical nephrectomy along with venous thrombectomy from two centers in Canada from 2002 to 2012 by dedicated laparoscopic surgeons. Technique of laparoscopic radical nephrectomy and caval thrombectomy in this series will be described.
Results
The mean age and body mass index of the 44 study patients (M:F = 35:9) were 64.7years and 29.1kg/m2 respectively. Median tumor size was 8.9cm, 42 patients had RV thrombus and 2 had IVC thrombus. Seven (16%) patients had undergone previous abdominal surgeries. Nine patients (20.5%) had metastatic disease to begin with and underwent laparoscopic cytoreductive nephrectomy. Median estimated blood loss, operative time and length of stay were 100mL (range 50-400), 134.5 minutes (range 99-183) and 4 days (range 4-6) respectively. There were 2 (4.6%) intra-operative and 5 (11.6%) peri-operative complications. Three (7%) patients required blood transfusions peri-operatively. There was no intra-operative death. Mean duration of follow-up was 42 months (range 6-107). Eight (18%) patients died due to progressive disease and 3 (7%) patients died due to unrelated causes. Twenty nine (66%) patients were alive at the end of follow-up period. Out of these 21 (48%) were disease free and 8 (18%) had local or systemic disease progression. Three patients lost to follow-up.
Conclusion
Laparoscopic radical nephrectomy and venous thrombectomy for advanced renal tumors with venous thrombus is a safe procedure in experienced hands with significant laparoscopic skills. The short-term oncological data is encouraging and advocates the efficacy of this procedure in this subset of patients.
Laparoscopic Management of Advanced Renal Cell Carcinoma with Renal Vein and Inferior Vena Cava Thrombus.
Rahul Bansal, Anil Kapoor, Bobby Shayegan, J Paul Whelan and Darrel Drachenberg
Abstract
Introduction & Objectives
The traditional open surgical method of resection of renal mass with removal of venous thrombus has paved the way for laparoscopic radical nephrectomy (LRN) and venous thrombectomy in multiple case reports and case series. The goal of this study is to report the results and oncological efficacy of LRN in patients of renal cell carcinoma (RCC) with renal vein (RV) and inferior vena cava (IVC) thrombus.
Patients and Methods
We performed retrospective chart review of 44 patients who underwent laparoscopic radical nephrectomy along with venous thrombectomy from two centers in Canada from 2002 to 2012 by dedicated laparoscopic surgeons. Technique of laparoscopic radical nephrectomy and caval thrombectomy in this series will be described.
Results
The mean age and body mass index of the 44 study patients (M:F = 35:9) were 64.7years and 29.1kg/m2 respectively. Median tumor size was 8.9cm, 42 patients had RV thrombus and 2 had IVC thrombus. Seven (16%) patients had undergone previous abdominal surgeries. Nine patients (20.5%) had metastatic disease to begin with and underwent laparoscopic cytoreductive nephrectomy. Median estimated blood loss, operative time and length of stay were 100mL (range 50-400), 134.5 minutes (range 99-183) and 4 days (range 4-6) respectively. There were 2 (4.6%) intra-operative and 5 (11.6%) peri-operative complications. Three (7%) patients required blood transfusions peri-operatively. There was no intra-operative death. Mean duration of follow-up was 42 months (range 6-107). Eight (18%) patients died due to progressive disease and 3 (7%) patients died due to unrelated causes. Twenty nine (66%) patients were alive at the end of follow-up period. Out of these 21 (48%) were disease free and 8 (18%) had local or systemic disease progression. Three patients lost to follow-up.
Conclusion
Laparoscopic radical nephrectomy and venous thrombectomy for advanced renal tumors with venous thrombus is a safe procedure in experienced hands with significant laparoscopic skills. The short-term oncological data is encouraging and advocates the efficacy of this procedure in this subset of patients.
Rahul Bansal, Anil Kapoor, Bobby Shayegan, J Paul Whelan and Darrel Drachenberg
Abstract
Introduction & Objectives
The traditional open surgical method of resection of renal mass with removal of venous thrombus has paved the way for laparoscopic radical nephrectomy (LRN) and venous thrombectomy in multiple case reports and case series. The goal of this study is to report the results and oncological efficacy of LRN in patients of renal cell carcinoma (RCC) with renal vein (RV) and inferior vena cava (IVC) thrombus.
Patients and Methods
We performed retrospective chart review of 44 patients who underwent laparoscopic radical nephrectomy along with venous thrombectomy from two centers in Canada from 2002 to 2012 by dedicated laparoscopic surgeons. Technique of laparoscopic radical nephrectomy and caval thrombectomy in this series will be described.
Results
The mean age and body mass index of the 44 study patients (M:F = 35:9) were 64.7years and 29.1kg/m2 respectively. Median tumor size was 8.9cm, 42 patients had RV thrombus and 2 had IVC thrombus. Seven (16%) patients had undergone previous abdominal surgeries. Nine patients (20.5%) had metastatic disease to begin with and underwent laparoscopic cytoreductive nephrectomy. Median estimated blood loss, operative time and length of stay were 100mL (range 50-400), 134.5 minutes (range 99-183) and 4 days (range 4-6) respectively. There were 2 (4.6%) intra-operative and 5 (11.6%) peri-operative complications. Three (7%) patients required blood transfusions peri-operatively. There was no intra-operative death. Mean duration of follow-up was 42 months (range 6-107). Eight (18%) patients died due to progressive disease and 3 (7%) patients died due to unrelated causes. Twenty nine (66%) patients were alive at the end of follow-up period. Out of these 21 (48%) were disease free and 8 (18%) had local or systemic disease progression. Three patients lost to follow-up.
Conclusion
Laparoscopic radical nephrectomy and venous thrombectomy for advanced renal tumors with venous thrombus is a safe procedure in experienced hands with significant laparoscopic skills. The short-term oncological data is encouraging and advocates the efficacy of this procedure in this subset of patients.
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