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About one third of newly diagnosed renal cell carcinoma (RCC) patients present with synchronous metastatic disease. Twenty to 40 % with localized disease at diagnosis eventually develop metastases. Complete metastasectomy confers five year survival rate of 35 % to 50 %. Traditional thoracic approach for lung metastasectomy carries increased morbidity. We report a less morbid trans-diaphragmatic approach. Right cytoreductive nephrectomy with liver and simultaneous trans-diaphragmatic lung resection was performed with uneventful perioperative course in a 60 year male with metastatic RCC. Trans-diaphragmatic resection of peripheral lung metastasis can be considered electively approach in selective cases of RCC with ipsilateral resectable inferior lung metastases.

Simultaneous Trans-Diaphragmatic Approach for Wedge Resection of the Solitary Ipsilateral Lung Metastasis in Renal Cell Carcinoma