Extension - surgical technique

Abstract

Introduction: Surgical technique for left renal cell carcinoma with infradiaphragmatic caval extension is presented. Technique: A transperitoneal bilateral subcostal approach was used. After left colon reflection, the renal artery is ligated and divided, the left renal vein is dissected on. The right colon reflection is perform ed, the right renal vein and vena cava is dissected. Satinsky clamp is placed on infrarenal vena cava, a bulldog clamp is placed on the right renal vein and a Satinsky clamp is placed on vena cava above the thrombus. Circular incision on vena cava at the level of left renal vein is performed and en block perifascial nephrectomy including the thrombus is done. The vena cava incision is repaired with a continuos 4-0 vascular suture. Extensive lymph node dissection is performed. Conclusions: Out of more than 1305 RCC operated in our Department between 1975 - 2000, 142 cases have had caval extension. Using appropriate surgical technique, the patient's survival is almost similar to those without caval extension.