To investigate the safety and efficacy of laparoscopic surgery, including conventional laparoscopy and robot-assisted laparoscopy, in the treatment of renal cell carcinoma with vein tumor thrombosis.

A retrospective analysis was performed on the clinical data of 18 patients of renal cell carcinoma with vein tumor thrombosis under laparoscopic surgery including conventional laparoscopy and robot-assisted laparoscopy in Shanghai Changzheng Hospital from Feb. 2016 to Dec. 2018, with an average age of (59.7±10.1) years (range 32-77, 14 men and 4 women); Their average preoperative creatinine level was (94.2±26.2)μmol/L (ranged 53- 147 μmol/L); The tumors were located on the left side in 6 patients and the right side in 12 patients; There were 5 cases of grade 0, 6 cases of grade Ⅰ and 7 cases of grade Ⅱ for venous tumor thrombus based on Mayo Grading System. Conventional laparoscopic surgeries were performed in 6 patients and 12 patients were under robot-assisted laparoscopic surgeries.

All surgeries were completed successfully without conversion to laparotomy. Transabdominal approach was adopted during the surgery and the specific surgical procedures were different according to the grade of tumor thrombus and tumor location. The mean operation time was(295.2±123.7)minutes (range165-615 min). The average blood loss was(458.3±431.8)ml (range 100-1 500 ml), and 6 patients were intraoperative blood transfused. The final pathology revealed clear-cell, papillary and composed of an eosinophilic subtype of chromophobe renal cell carcinoma in 13, 4 and 1 patient, respectively. The mean follow-up period was 14 months(range 1-34 months) of all 18 patients and 1 patient died after 20 months.

Laparoscopic surgery, including conventional laparoscopy and robot-assisted laparoscopy, is a safe and effective treatment for patients of renal cell carcinoma with vein tumor thrombosis, especially those with grade Ⅱ or below. However, the specific operation scheme should be formulated by combination with the patient′s tumor location, the grade of the tumor thrombus and the proficiency of the surgeon, so as to maximize the benefits for the patient.