Laparoscopic Left Nephrectomy with “En Bloc” Distal Splenopancreatectomy

Background Multiorgan resection for cancer is considered a demanding laparoscopic procedure. We report a laparoscopic radical nephrectomy and distal splenopancreatectomy for a locally advanced kidney tumor. Methods A 67-year-old woman presented with left flank pain and hematuria. CT scan showed a le...

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Bibliographic Details
Published in:Annals of surgical oncology 2012-02, Vol.19 (2), p.693-693
Main Authors: Huscher, Cristiano Germano, Mingoli, Andrea, Sgarzini, Giovanna, Mereu, Andrea
Format: Article
Language:English
Subjects:
Aged
Carcinoma, Renal Cell - surgery
Female
Humans
Kidney - blood supply
Kidney - surgery
Kidney Neoplasms - surgery
Laparoscopy - methods
Medicine
Medicine & Public Health
Neoplasm Invasiveness
Nephrectomy - methods
Oncology
Pancreatectomy - methods
Splenectomy - methods
Surgery
Surgical Oncology
Urologic Oncology
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Summary:Background Multiorgan resection for cancer is considered a demanding laparoscopic procedure. We report a laparoscopic radical nephrectomy and distal splenopancreatectomy for a locally advanced kidney tumor. Methods A 67-year-old woman presented with left flank pain and hematuria. CT scan showed a left kidney upper pole large mass with direct extension to spleen and pancreatic tail, but not metastases. With the patient on the right flank, three 10-mm trocars were placed forming an isosceles triangle in the left subcostal arch. Entering the lesser sac, splenic vessels were separately divided between clips. The pancreatic tail was dissected free and divided with Ultracision. The left renal vein was dissected free, and the aorta was exposed to perform the lymphadenectomy. Superior mesenteric artery and left renal vein and artery were isolated, and renal vessels were separately divided with a vascular stapler. The left kidney was mobilized. The specimen was inserted in a bag and retrieved transvaginally through a posterior colpotomy. Results Total operation time was 210 minutes. Estimated blood loss was 250 mL. The patient was discharged after 7 days. Final stage of disease was pT4N0M0 G2 R0 renal cell carcinoma. The patient came back 6 years later presenting a ductal adenocarcinoma of pancreatic head. At the second look laparoscopy, very few adhesions were found in right upper quadrant, and the posterior colpotomy scar was very small. The patient died 1 year after Whipple operation. Conclusions Oncologic rules of an “en bloc” resection can be respected also with a laparoscopic approach.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-011-1966-y