Laparoscopic management of interaortocaval metastases of renal cell carcinoma

Introduction: Complete resection of metastatic lesions may offer a survival advantage in patients with metastatic renal cell carcinoma (RCC). Laparoscopy might play a role in this arena by decreasing operative morbidity and shortening convalescence. Technique: An 84-year-old woman presented with a 5-cm interaortocaval mass on routine computed tomography scan 5 years after margin-negative right radical nephrectomy for pT3aN0Mx RCC. There were no other apparent metastases. A five-port approach was employed for laparoscopic excision of the interaortocaval mass. Operating time was 174 minutes. Estimated blood loss was 700 mL. Hospital stay was 2 days. Time for complete convalescence was 2 weeks. Histopathology confirmed metastatic RCC. The patient remains recurrence-free at 6 months. Role in Urological Practice: A laparoscopic approach for excision of RCC metastases in the vicinity of the great vessels is technically feasible. This may even be the preferred approach in the hands of advanced laparoscopists given the potential for rapid recovery.