Metastatic retroperitoneal renal cell carcinoma. A case for more aggressive approach. Risk and results.

Our point of view in selected cases of bulky renal neoplastic disease was shown. A 43-year-old white man was referred for large disseminated retroperitoneal mass after right radical nephrectomy and hilar lymphadenectomy for locally advanced PT3 N3 M0 G3 renal cell carcinoma followed by interleukin-2 based immunotherapy. We attempted aggressive resection of visible disease with curative intent. Complete resection was technically very difficult with intraoperative bleeding representing the major risk. Accidental injuries of aortic wall and vena cava were repaired. A partial incision of the right external iliac vein was performed. Complete removal of the large adenopathy masses was obtained. At 9 month follow-up the patient was free of disease. In conclusion, aggressive surgical approach with complete resection of disseminated retroperitoneal renal cell carcinoma may prolong disease-free survival.