Manzanilla-García HA, Lira-Dale A, Rosas-Nava E, Almanza-González MS

Language: Spanish
References: 25
Page: 196-201
PDF size: 371.97 Kb.

ABSTRACT

Background: Since the introduction of nephron-sparing surgery, patients with small renal masses and diseases affecting overall renal function have greatly benefited.
Clinical case: We present the case of a 62-year-old male with a 6-cm left renal tumor in the medial parahilar segment with right renal unit functionally excluded, secondary to chronic obstruction due to ureteral lithiasis. Right ureteroscopy was performed with pneumatic lithotripsy. Despite localization and size of the tumor, left nephron-sparing surgery was performed in order to preserve renal function. Follow-up of the patient demonstrates no tumor activity.
Conclusions: Open nephron-sparing surgery has been the standard treatment for small renal masses with peripheral localization; however, in specific cases with deteriorated renal function and tumors ›5 cm close to the renal hilum, certain risk must be taken in order to perform this procedure that has proven to be highly effective in preserving renal function. Open nephronsparing surgery represents a highly effective procedure in small renal masses with a nonfunctional contralateral kidney.

REFERENCES

1. Herr H. A history of partial nephrectomy for renal tumors. J Urol 2005;173:705-708.

2. Uzzo RG, Novick AC. Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 2001;166:6-18.

3. Tada S, Yamagishi IJ, Kobayashi H, Hata Y, Kobari T. The incidence of simple renal cyst by computed tomography. Clin Radiol 1983;34:437-439.

4. Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 2003;170:2217-2220.

5. Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DY, Uzzo RG. The natural history of observed enhancing renal masses: metaanalysis and review of the world literature. J Urol 2006;175:425-431.

6. Klatte T, Patard JJ, de Martino M, Bensalah K, Verhoest G, de la Taille A, et al. Tumor size does not predict risk of metastatic disease or prognosis of small renal cell carcinomas. J Urol 2008;179: 1719-1726.

7. Lau WK, Cheville JC, Blute ML, Weaver AL, Zincke H. Prognostic features of pathologic stage T1 renal cell carcinoma after radical nephrectomy. Urology 2002;59:532-537.

8. Nguyen CT, Campbell SC, Novick AC. Choice of operation for clinically localized renal tumor. Urol Clin North Am 2008;35:645-655.

9. Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD 3rd, Dupuy DE, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology 2005;235:728-739.

10. Lerner SE, Hawkins CA, Blute ML, Grabner A, Wollan PC, Eickholt JT, et al. Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. J Urol 1996;155:1868-1873.

11. Timsit MO, Bazin JP, Thiounn N, Fontaine E, Chrétien Y, Dufour B, et al. Prospective study of safety margins in partial nephrectomy: intraoperative assessment and contribution of frozen section analysis. Urology 2006;67:923-926.

12. Matin SF, Gill IS, Worley S, Novick AC. Outcome of laparoscopic radical and open partial nephrectomy for the sporadic 4 cm or less renal tumor with a normal contralateral kidney. J Urol 2002;168:1356-1359.

13. Huang WC. Impact of nephron sparing on kidney function and nononcologic mortality. Urol Oncol 2010;28:568-574.

14. Tompson RH, Frank I, Lohse CM, Saad IR, Fergany A, Zincke H, et al. The impact of ischemia time during open nephron sparing surgery on solitary kidneys: a multi-institutional study. J Urol 2007;177:471-476.

15. Tomita Y, Koike H, Takahashi K, Tamaki M, Morishita H. Use of the harmonic scalpel for nephron sparing surgery in renal cell carcinoma. J Urol 1998;159:2063-2064.

16. Dalpiaz O, Neururer R, Bartsch G, Peschel R. Haemostatic sealants in nephron-sparing surgery: what surgeons need to know. BJU Int 2008;102:1502-1508.

17. Rais-Bahrami S, Romero FR, Lima GC, Kohanim S, Permpongkosol S, Trock BJ, et al. Elective laparoscopic partial nephrectomy in patients with tumors ›4 cm. Urology 2008;72:580-583.

18. Meeks JJ, Zhao LC, Navai N, Perry KT Jr, Nadler RB, Smith ND.Risk factors and management of urine leaks after partial nephrectomy. J Urol 2008;180:2375-2378.

19. Gill IS, Aron M, Gervais DA, Jewett M. Small renal mass. N Engl J Med 2010;362:624-634.

20. Gill IS, Kavoussi L, Lane B, Blute M, Babineau D, Colombo JR, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 2007;178:41-46.

21. Gill IS, Kamoi K, Aron M, Desai MM. 800 Laparoscopic partial nephrectomies: a single surgeon series. J Urol 2010;183:34-41.