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- Title
Partial Nephrectomy for Multiple Renal Cell Carcinoma in a Patient with Solitary Kidney.
- Authors
Gingu, C.; Barbu, A.; Ianiotescu, S.; Dick, A.; Andresanu, A.; Orezanu, A.; Dragan, C.; Cairac, N.; Stamate, C.; Cerempei, V.; Domnisor, L.; Baston, C.; Sinescu, I.; Preda, A.
- Abstract
Introduction and Objectives. Renal cell carcinoma (RCC) represents about 3% of all cancers. The classic triad of flank pain, palpable abdominal mass and hematuria, is present in less than 10% of patients and as many as 60% of renal masses are detected incidentally. The treatment methods for renal tumors include radical nephrectomy and partial nephrectomy. Partial nephrectomy or nephron-sparing surgery (NSS) is considered the treatment of choice for localized small renal masses with oncological outcome in cases of renal cell carcinoma (RCC) similar to that of radical nephrectomy (RN). The aim of this paper is to present partial nephrectomy as a treatment method in a patient with multiple renal cell carcinoma on a solitary kidney. Materials and Methods. A 59 years old male patient who referred to our clinic with three renal masses on the left kidney. The patient had a history of right radical nephrectomy, performed 7 years prior, for a pT3aNxMx RCC. We opted for an open partial nephrectomy in order to preserve as much of the renal parenchyma as possible and avoid dialysis. After performing a left subcostal incision, we dissected the kidney and were able to identify the renal masses on the lower extremity of the kidney. After clamping the renal vessels we performed a wedge resection for all three tumors, while also being careful to keep a maximum amount of healthy renal tissue intact. We sutured the kidney and after adequate hemostasis, two drainage tubes were inserted using a small incision and the surgery was completed. Results. The operative time was 90 minutes with a warm ischemia time of 20 minutes. No major complications were encountered in the postoperative setting. The patient was discharged on the 8th postoperative day, with a subsiding creatinine level (from 3.49 mg/dL at the 48 hour mark to 1.79 mg/dL) and subsequent follow-ups have been nominal. The histopatological examination revealed clear cell renal carcinoma pT(m)3a pNx pMx. Conclusions. Nephron sparing surgery should always be considered when managing patients with renal tumors, especially in cases of solitary kidneys, in order to maintain normal renal function and avoid dialysis. While laparoscopic partial nephrectomies are feasible for patients with multiple RCCs, they should be avoided in solitary kidney cases, due to a longer warm ischemia time and higher blood loss when compared to the open approach. Open partial nephrectomy is the preferred approach for these types of patients at high risk for chronic kidney disease.
- Subjects
NEPHRECTOMY; RENAL cell carcinoma; SURGICAL site; DISEASE risk factors; KIDNEYS; CHRONIC kidney failure; KIDNEY tumors
- Publication
Romanian Journal of Urology, 2020, Vol 19, Issue 4, p48
- ISSN
1223-0650
- Publication type
Article