Renal cell carcinoma the most common type of kidney cancer. Typical presentation includes macroscopic haematuria, weight loss, and sometimes a palpable flank mass. Diagnosis involves imaging techniques, commonly CT. Management options include surveillance, thermal ablation, surgical resection, and systemic treatment options.

We describe the case of an 81 year old male with left papillary renal cell carcinoma with metastatic involvement of para-aortic nodes.

The patient had a background of previous testicular cancer treated with chemotherapy. This resulted in initial confusion due to the similar lymph node involvement pattern. The patient had prior external beam radiotherapy to the renal mass and nodes. A robotic salvage left radical nephrectomy and retroperitoneal lymph node dissection was performed with findings including a 5cm endophytic left renal mass, 10 removed lymph nodes with 2 appearing macroscopically involved. Histology demonstrated a 40x37x35 mm grade 3, stage 1 papillary renal cell carcinoma with tumour involvement of 3 out of 10 lymph nodes, with the largest deposit measuring 22mm in cross-section. The patient recovered well following the operation and was discharged after a short stay. His post-operative renal function demonstrated Cr 170 and eGFR 32.

Robotic salvage radical nephrectomy and retroperitoneal lymph node dissection after external beam radiotherapy for renal cell carcinoma was shown to be a safe and effective procedure for tumour clearance.