Nephron-sparing surgery in multiple renal cancer: a case report
DOI:
https://doi.org/10.7175/cmi.v11i1.1290Keywords:
Renal cancer, Cryoablation, Nephron Sparing SurgeryAbstract
BACKGROUND: In the last decade, nephron-sparing surgery has largely supplanted the radical approach for the treatment of small renal masses. More recently, ablative technologies have been discussed as alternative in patients that are not eligible for surgical approach.
CASE SUMMARY: A 54-year-old Caucasian man was referred to our Urology Clinic for multiple renal masses. A computed tomography (CT) scan revealed three contrast-enhanced lesions located in the upper pole, middle renal, and in the lower pole of the left kidney 20 mm, 25 mm, and 45 mm long, respectively. The patient underwent laparoscopic tumorectomy of two lesions and cryoablation of the left renal mass by the transperitoneal approach, performed without clamping the renal vessels. At the end of the procedure the operator posed a reno-ureteral ipsilateral stent to tutor the urinary tract. Tumor enucleation and cryoablation were chosen to preserve renal function.
CONCLUSION: This case report shows that in young patients with multiple renal tumors, cryoablation treatment is feasible and outcomes are promising as well. However, risk of complications should be considered and discussed with patients.
References
Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 2015; 67: 913-24; https://doi.org/10.1016/j.eururo.2015.01.005
Pantuck AJ, Zisman A, Belldegrun AS. The changing natural history of renal cell carcinoma. J Urol 2001; 166: 1611-23; https://doi.org/10.1016/S0022-5347(05)65640-6; https://doi.org/10.1097/00005392-200111000-00003
Hafez KS, Novick AC, Butler BP. Management of small solitary unilateral renal cell carcinomas: impact of central versus peripheral tumor location. J Urol 1998; 159: 1156-60; https://doi.org/10.1097/00005392-199804000-00010; https://doi.org/10.1016/S0022-5347(01)63537-7
Seror O. Ablative therapies: Advantages and disadvantages of radiofrequency, cryotherapy, microwave and electroporation methods, or how to choose the right method for an individual patient? Diagn Interv Imaging 2015; 96: 617-24; https://doi.org/10.1016/j.diii.2015.04.007
Abreu AL, Berger AK, Aron M, et al. Minimally invasive partial nephrectomy for single versus multiple renal tumors. J Urol 2013; 189: 462-7; https://doi.org/10.1016/j.juro.2012.09.039
Klatte T, Patard JJ, Wunderlich H, et al. Metachronous bilateral renal cell carcinoma: risk assessment, prognosis and relevance of the primary-free interval. J Urol 2007; 177: 2081-6; discussion 6-7; https://doi.org/10.1016/j.juro.2007.01.122
Gervais DA, McGovern FJ, Wood BJ, et al. Radio-frequency ablation of renal cell carcinoma: early clinical experience. Radiology 2000; 217: 665-72; https://doi.org/10.1148/radiology.217.3.r00dc39665
Raman JD, Jafri SM, Qi D. Kidney function outcomes following thermal ablation of small renal masses. World J Nephrol 2016; 5: 283-7; https://doi.org/10.5527/wjn.v5.i3.283
Wehrenberg-Klee E, Clark TW, Malkowicz SB, et al. Impact on renal function of percutaneous thermal ablation of renal masses in patients with preexisting chronic kidney disease. J Vasc Interv Radiol 2012; 23: 41-5; https://doi.org/10.1016/j.jvir.2011.09.002
Thompson RH, Atwell T, Schmit G, et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol 2015; 67: 252-9; https://doi.org/10.1016/j.eururo.2014.07.021
Atwell TD, Vlaminck JJ, Boorjian SA, et al. Percutaneous cryoablation of stage T1b renal cell carcinoma: technique considerations, safety, and local tumor control. J Vasc Interv Radiol 2015; 26: 792-9; https://doi.org/10.1016/j.jvir.2015.02.010
Nielsen TK, Lagerveld BW, Keeley F, et al. Oncological outcomes and complication rates after laparoscopic-assisted cryoablation: a European Registry for Renal Cryoablation (EuRECA) multi-institutional study. BJU Int 2017; 119: 390-5; http://dx.doi.org/10.1111/bju.13615
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-13; https://doi.org/10.1097/01.sla.0000133083.54934.ae
Kapoor A, Touma NJ, Dib RE. Review of the efficacy and safety of cryoablation for the treatment of small renal masses. Can Urol Assoc J 2013; 7: E38-E44; https://doi.org/10.5489/cuaj.193
Sprenkle PC, Power N, Ghoneim T, et al. Comparison of open and minimally invasive partial nephrectomy for renal tumors 4-7 centimeters. Eur Urol 2012; 61: 593-9; https://doi.org/10.1016/j.eururo.2011.11.040
Sidana A, Aggarwal P, Feng Z, et al. Complications of renal cryoablation: a single center experience. J Urol 2010; 184: 42-7; https://doi.org/10.1016/j.juro.2010.03.013
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