Transmesenteric approach in the surgical treatment of left kidney cancer with venous tumor thrombus of Mayo levels 0–I

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Abstract

Aim – to evaluate the efficacy and safety an original transmesenteric approach for laparoscopic nephrectomy with thrombectomy in patients with left kidney cancer and venous tumor thrombus (levels 0–I according to the Mayo classification).

Material and methods. The study included 19 patients with histologically verified left kidney cancer who underwent laparoscopic nephrectomy with thrombectomy using a transmesenteric approach. Eleven patients had renal vein thrombus (Mayo level 0), and eight patients had thrombus extending into the inferior vena cava up to 2 cm from the renal vein orifice (Mayo level I). The following parameters were assessed: age, body mass index, operative time, intraoperative blood loss, hospital stay, and postoperative complications.

Results. All procedures were completed laparoscopically without conversion. The mean operative time was 125.8 ± 11.4 min, and the mean blood loss was 152.6 ± 62.9 ml. The mean hospital stay was 7.4 ± 0.6 days. No early or late complications were recorded. Operative time and blood loss were significantly lower compared to previously published series of laparoscopic and open procedures. Conclusion. The transmesenteric approach minimizes surgical trauma, reduces operative time and blood loss, and lowers the risk of complications while maintaining oncological radicality. The method can be recommended for widespread use in onco-urological practice.

About the authors

Musabek K. Mirzabekov

Granov Russian Research Center of Radiology and Surgical Technologies

Author for correspondence.
Email: Musabek.mirzabekoff@yandex.ru
ORCID iD: 0009-0003-8365-7672

Postgraduate Student of the Department of Radiology, Surgery and Oncology

Russian Federation, Saint Petersburg

Mikhail I. Shkolnik

Granov Russian Research Center of Radiology and Surgical Technologies

Email: shkolnik_phd@mail.ru
ORCID iD: 0000-0003-0589-7999

MD, Dr. Sci. (Medicine), Associate Professor, Chief Researcher, Professor of the Department of Radiology, Surgery and Oncology

Russian Federation, Saint Petersburg

Oleg A. Bogomolov

Granov Russian Research Center of Radiology and Surgical Technologies

Email: urologbogomolov@gmail.com
ORCID iD: 0000-0002-5860-9076

MD, Cand. Sci. (Medicine), Senior Researcher, Associate Professor of the Department of Radiology, Surgery and Oncology

Russian Federation, Saint Petersburg

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2. Figure 1. Stages of transmesenteric approach formation: a – creation of a window in the mesentery of the descending colon; b – completed access to the left kidney, left renal vein with tumor thrombus in its lumen.

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3. Figure 2. Distribution of patient age in the study cohort (n = 19).

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4. Figure 3. Distribution of body mass index (BMI) in the study cohort (n = 19).

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5. Figure 4. Distribution of hospital stay (bed-days) in the study cohort (n = 19).

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6. Figure 5. Distribution of intraoperative blood loss in the study cohort (n = 19).

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7. Figure 6. Distribution of operative time in the study cohort (n = 19).

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Copyright (c) 2025 Mirzabekov M.K., Shkolnik M.I., Bogomolov O.A.

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