Nephron-Sparing Surgery for Renal Cell Carcinoma with Tumor Thrombus

<b><i>Objective:</i></b> The aim of the study was to describe our experience in patients who underwent nephron-sparing surgery (NSS) with tumor thrombectomy. <b><i>Patients and Methods:</i></b> Three consecutive patients who underwent NSS and tumor thrombectomy for localized single/multifocal renal cell carcinomas (RCCs) in conjunction with tumor thrombus between 2007 and 2011 were included. Open partial nephrectomy and thrombectomy was performed. Reconstruction included main renal vein, collecting system, and remaining parenchymal closure. One of the cases required additional artery repair and flushing with preservation solution. <b><i>Results:</i></b> Ischemic time was kept for 30–40 min. Mean estimated blood loss was 183.3 cc (range:100–300). One patient required the transfusion of 1 packed red blood cells unit. One of the patients developed a urinary fistula requiring double-J stenting. Hospital staying ranged between 5 and 8 days. None of the patients required renal replacement therapy either postoperatively or in the follow-up. Serum creatinine level at last follow-up (mean 83 months) ranged from 0.8 to 2.8 mg/dL. <b><i>Conclusion:</i></b> Our experience supports the feasibility of imperative partial nephrectomy and tumor thrombectomy for cases of RCC with renal vein involvement by tumor thrombus. In experienced hands, this approach may offer the patient a low morbidity postoperative course and long-term freedom from disease while maintaining the renal function, thus avoiding the need of renal replacement therapy.