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Organo Oficial de la Sociedad Mexicana de Urología

2012, Number 3

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Rev Mex Urol 2012; 72 (3)

Multiple organ resection in renal cancer

Castellanos-Hernández H, Solares-Sánchez ME, Sánchez-Turati JG, Martínez-Cervera PF, Chanona-Vilchis G, Pérez-Montiel D, Jiménez-Ríos MÁ

Language: Spanish
References: 15
Page: 131-135
PDF size: 367.48 Kb.


ABSTRACT

Invasion beyond Gerota’s fascia into adjacent organs, without concomitant metastatic disease, is unusual. A 5 to 15% incidence of stage pT4 renal cell carcinoma (RCC) has been reported. Despite the lack of evidence of metastatic disease, patients suspected of having RCC are often labeled “unresectable” and “incurable” and are given palliative treatment.
The case is presented of a 58-year-old man with a left renal tumor that invaded the spleen. Left radical nephrectomy was performed with multiorgan resection (splenectomy and hemipancreatectomy).
The case is also presented of a 63-year-old man with left lumbar pain. Abdominopelvic computed axial tomography scan showed an 8.3 cm left renal tumor with multiple retroperitoneal adenopathies. Extension studies were negative for metastatic disease. The patient presented with bleeding of the lower digestive tract and synchronous second primary cancer of the colon was determined. Surgery revealed a renal tumor that involved the Gerota’s capsule and infiltrated the left colonic mesenterium, as well as a tumor in the left colon at the splenic angle and a retroperitoneal nodal conglomerate. Oncologic en bloc resection was performed (left hemicolectomy, left radical nephrectomy). Renal cell carcinoma involvement of adjacent organs with no clinical evidence of systemic metastases is rare (1%). Patients frequently present with large, poorly differentiated tumors and have a high probability of lymph node metastases, tumor thrombus, and adrenal gland involvement.
In regard to pathologic stage, acceptable morbidity and lasting disease-free survival are expected in a portion of patients after radical nephrectomy with en bloc resection of the involved organs.


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