1268 ONCOLOGIC OUTCOMES OF ENUCLEATIVE SURGERY FOR HIGH GRADE CLEAR CELL RENAL CELL CARCINOMA IN VON HIPPEL LINDAU PATIENTS

Abstract

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111268 ONCOLOGIC OUTCOMES OF ENUCLEATIVE SURGERY FOR HIGH GRADE CLEAR CELL RENAL CELL CARCINOMA IN VON HIPPEL LINDAU PATIENTS Heinric Williams, Anup Vora, Angelo Baccala, Peter Pinto, W. Marston Linehan, and Gennady Bratslavsky Heinric WilliamsHeinric Williams Bethesda, MD More articles by this author , Anup VoraAnup Vora Georgetown, DC More articles by this author , Angelo BaccalaAngelo Baccala Bethesda, MD More articles by this author , Peter PintoPeter Pinto Bethesda, MD More articles by this author , W. Marston LinehanW. Marston Linehan Bethesda, MD More articles by this author , and Gennady BratslavskyGennady Bratslavsky Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.953AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While enucleative surgery for sporadic renal cell carcinoma (RCC) is not routinely practiced because of concerns for local recurrence, there have been recent reports supporting this technique for sporadic renal masses. Patients with von Hippel Lindau (VHL) develop multiple clear cell carcinomas that are routinely treated with enucleative resection when the largest lesion reaches 3 cm. Since we are unable to identify high grade lesions preoperatively, our patient population provides us with unique opportunity to assess the oncologic outcomes of patients treated with enucleative surgery for high grade lesions. METHODS VHL patients treated at the National Cancer Institute between 1990 and 2010 with enucleative partial nephrectomy and found to have high grade (Fuhrman Grade 3 or 4) clear cell RCC on final pathology were included in this study. Patients were excluded if they had evidence of metastatic disease at the time of surgery. The pathology reports were reviewed for the number and size of all and high grade lesions removed. The oncologic outcomes were assessed by the need and time to repeat intervention on the same renal unit and development of metastatic disease. RESULTS We identified 44 renal enucleative surgeries for high grade clear cell RCC that were performed in 35 patients. The average number of tumors removed was 5.8 (1 °C 20) with the average number of high grade tumors of 1.75 (1–15). The average size of the high grade lesions was 3.5 cm (0.7 to 7). After a median follow-up of 73.2 months (1 to 222 months), five patients (14.3%) developed metastatic disease with 1 patient (3%) dying from the disease. The average size of renal tumors for patients with metastatic disease was significantly larger than those in patients with non metastatic disease (5.1 cm vs 3.5 cm, p=0.02). Reintervention on the same renal unit was required in 12 of 44 renal units (27%) and included 7 subsequent partial nephrectomies, 2 total nephrectomies, and 3 radio frequency ablations. The median time to reintervention on the same unit was 53 months (9–116). CONCLUSIONS The oncologic outcomes of surgery for high grade lesions do not seem to be compromised with enucleative resection. In patients with high grade tumors, size appears to be influencing the development of metastatic disease. Despite encouraging oncologic outcomes in VHL patients, application of the resection via enucleation in the sporadic RCC population would need further validation. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e507 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Heinric Williams Bethesda, MD More articles by this author Anup Vora Georgetown, DC More articles by this author Angelo Baccala Bethesda, MD More articles by this author Peter Pinto Bethesda, MD More articles by this author W. Marston Linehan Bethesda, MD More articles by this author Gennady Bratslavsky Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...