Laparoscopic radical nephrectomy for patients with pathologic T3b renal-cell carcinoma: the Johns Hopkins experience

Surgical therapy for renal-cell carcinoma (RCC) with vascular involvement has traditionally been performed via an open approach. As laparoscopic techniques have improved, more surgeons are attempting laparoscopic nephrectomy for higher stage RCC. The goal of our study was to evaluate the safety and short-tem oncologic efficacy of laparoscopic radical nephrectomy in patients with renal vein involvement.

We reviewed the clinical and pathologic data for 37 patients who underwent a pure laparoscopic radical nephrectomy for RCC with renal vein thrombus from 2005 to 2008 by dedicated laparoscopic surgeons. Perioperative and oncologic outcomes were assessed. Median age of our study population was 65 years, and mean follow-up was 14 months.

Median pathologic tumor size was 7.5 cm. One (2.7%) patient needed conversion to an open procedure. Median estimated blood loss (EBL) was 200 mL (interquartile range [IQR]) 100-850), and median length of stay (LOS) was 3 days (range 3-5 d). The overall perioperative complication rate was 14%, and there were no perioperative mortalities. Of the 32 patients without metastatic disease at the time of surgery, 29 (91%) are alive without evidence of disease.

Laparoscopic radical nephrectomy in the setting of renal vein thrombus is a complex surgical procedure that necessitates significant laparoscopic skills. Our data demonstrate that laparoscopic radical nephrectomy is safe and effective in patients with RCC who have renal vein involvement, albeit with short-term oncologic follow-up. Long-term follow-up in larger series of patients is necessary to further define the role of laparoscopic nephrectomy in this subset of patients.