title: Laparoscopic management of renal tumors with macroscopic level 1 renal vein involvement.
abstract: OBJECTIVE
  To describe our surgical experience and clinical outcome in laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) with level 1 renal vein tumor thrombus.
  
  
  METHODS
  11 patients with RCC level 1 renal vein tumor thrombus were treated by LRN plus thrombectomy. The mean age was 66.8 years (SD ±11.313); the mean body mass index was 24.76 (SD ±5.091). In all cases, the surgical technique was defined by tumor characteristics and the surgeon's preferences.
  
  
  RESULTS
  Surgery was technically successful in all 11 patients. A hand-assisted approach was performed in 3 patients, while pure laparoscopy was used in 8. The mean surgical time was 108.3 min (SD ±28.284); the mean estimated blood loss was 108.33 ml (SD ±106.066); the average hospital stay was 2.8 days (SD ±0.707). There was 1 intraoperative complication (splenic laceration) that was managed laparoscopically. Pathologic examination confirmed RCC in all cases. There were no positive surgical margins. With a mean follow-up of 29 months (27-39), 2 patients had a recurrence.
  
  
  CONCLUSIONS
  This report provides further evidence of the technical feasibility, safety and oncologic adequacy of the laparoscopic approach in RCC with level 1 renal vein involvement. A longer follow-up and multi-institutional studies are needed to adequately evaluate its potential oncologic benefit.
authors.affiliation: Clínica INDISA, Santiago, Chile.
authors.forename: Octavio
authors.initials: O
authors.lastname: Castillo
authors.forename: Andrés
authors.initials: A
authors.lastname: Silva
authors.forename: Enrique
authors.initials: E
authors.lastname: Alemán
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D010690:Phlebography / Q000379:methods; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000473:pathology / Q000601:surgery*