Approach to the Management of Large and Advanced Renal Tumors

  • Bimal Bhindi
  • Bradley C. LeibovichEmail author


The safe and efficacious surgical management of large and advanced renal tumors begins with careful preoperative evaluation and planning. The choice of surgical exposure and approach must be tailored to the tumor size, location, and relevant patient anatomy. Radical nephrectomy should be performed while respecting normal anatomic relationships, even where there is distortion by the tumor. The management of an associated venous thrombus depends on its level. Such cases should be approached as a predominantly vascular procedure, with renal artery control first, venous tumor thrombectomy second, and radical nephrectomy third. Renal cancers invading adjacent structures can be resected en bloc if needed. Although surgery for nonmetastatic advanced renal cancers carries a nontrivial risk of morbidity and mortality, satisfactory oncologic outcomes can be achieved with a thoughtful surgical approach.


Renal tumor Renal cell carcinoma Advanced renal cell carcinoma Radical nephrectomy VTT Nephrectomy Inferior vena cava tumor thrombectomy 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyMayo ClinicRochesterUSA
  2. 2.Southern Alberta Institute of UrologyCalgaryCanada

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