Partial Nephrectomy of Renal Cell Carcinoma in Horseshoe Kidney with Assistance of Intraoperative Retrograde Pyelogram: A Case Report and Literature Review

ASSESSMENT OF TUMOR INVASION OF THE VENA CAVAL WALL IN RENAL CELL CARCINOMA CASES BY MAGNETIC RESONANCE IMAGING

Horseshoe kidney (HSK) is the most common congenital renal fusion anomaly. While the incidence of renal cell carcinoma (RCC) in HSK is not higher than in anatomically normal kidneys, altered renal anatomy makes surgical management technically challenging. Minimally invasive, image-guided therapies such as microwave ablation (MWA) have emerged as promising alternatives. We present the case of a 65-year-old male with HSK and a 2.0 cm RCC in the right renal moiety who underwent CT-guided MWA with no complications. Hydrodissection was used to protect the psoas muscle and lumbosacral nerves. Follow-up imaging confirmed local tumor control with no signs of remnant or recurrence. Only a limited number of similar cases have been reported. This case highlights the feasibility and safety of percutaneous MWA for RCC in HSK. It adds to the growing evidence supporting MWA as a minimally invasive option in anatomically complex renal tumors.

Renal cell carcinoma in a horseshoe kidney treated with robot-assisted partial nephrectomy

Renal Cell Carcinoma in Horseshoe Kidney With Vena Caval Involvement

Robotic-assisted laparoscopic partial nephrectomies (RAPN) have come up to standard treatment for small renal tumors, with a growing indication to accomplish this procedure. Although a horseshoe kidney is one of the most common congenital renal fusion anomalies, surgical planning for tumors is considered difficult because of its poor mobility and abnormal vascular supply. We showed our experience of RAPN in combination with conventional laparoscopic kidney mobilization and dissection for a patient with renal cell carcinoma in a horseshoe kidney. The patient was an otherwise healthy 66-year-old man with 26mm right renal mass on the lower pole of the horseshoe kidney. Robotic assistance allows for proper tissue dissection, easy to aware unconfirmed vasculatures, and meticulous fine suturing and would overcome the potential challenges involved in the minimally invasive management of such complex anomalies as shown in the patient.

IntroductionIn this case report, we demonstrate our technique of a retroperitoneal laparoscopic heminephrectomy for a T1b right hilar tumor in a horseshoe kidney.Case presentationA 77-year-old Vietnamese woman presented to the hospital because of right flank pain. On presentation, her serum creatinine was 0.86 mg/dL and glomerular filtration rate was 65.2 mL/minute/1.73 m2. According to her renal scintigraphy, glomerular filtration rates of the right and left moieties were 24.2 and 35.5 mL/minute, respectively. Computed tomography imaging demonstrated a 5.5 × 5.0 cm solid hilar mass with a cT1bN0M0 tumor stage was in the right moiety. After discussion, the patient elected a minimally invasive surgery to treat her malignancy. The patient was placed in a flank position. We used Gaur’s balloon technique to create the retroperitoneal working space, and four trocar ports were planned for operation. Three arteries were dissected, including two arteries feeding the right moiety, one artery feeding the isthmus, and one vein, which was clipped and divided by Hem-o-lok. The isthmusectomy was performed with an Endostapler. Consequently, the ureter was clipped and divided. Finally, the whole right segment of the horseshoe kidney was mobilized and taken out via the flank incision.ResultsThe total operative time was 250 min with an estimated blood loss of 200 mL. The patient's serum creatinine after surgery was 1.08 mg/dL, and glomerular filtration rate was 49.47 mL/minute/1.73 m2. The patient was discharged on postoperative day #4 without complication. Final pathologic examination of the tumor specimen revealed a Fuhrman grade II clear cell renal cell carcinoma, capsular invasion, with negative surgical margins. After a three-month follow-up, the serum creatinine was 0.95 mg/dL, and glomerular filtration rate was 57.7 mL/minute/1.73 m2. Local recurrence or metastasis was not detected by follow-up computed tomography imaging.ConclusionsRetroperitoneal laparoscopic heminephrectomy is a safe and feasible technique for patients with renal cell carcinoma in a horseshoe kidney and may be particularly useful in low income settings without access to robotic technology.

IntroductionHorseshoe kidney is a renal fusion anomaly often associated with ectopia, malformation, and vascular changes. Robot‐assisted partial nephrectomy is selected for patients with T1a renal cell carcinoma; however, there are few reports of renal cell carcinoma in horseshoe kidney. We present a case of robot‐assisted partial nephrectomy via a retroperitoneal approach in a patient with horseshoe kidney with a brief literature review.Case presentationAn 84‐year‐old woman presented with a 2‐cm mass in horseshoe kidney. She underwent robot‐assisted laparoscopic partial nephrectomy via a retroperitoneal approach.ConclusionThe use of robot‐assisted laparoscopic partial nephrectomy in patients with horseshoe kidney is very rare, and only four cases have been reported. Because of the unique anatomical structure, surgeons need to consider surgical strategy more carefully, considering tumor location, vascular anatomy, and past history of abdominal surgery.

Focus on kidney cancer

Robot-assisted partial nephrectomy (RAPN) has become the standard treatment for small renal tumors, including highly complex cases. However, applying RAPN to renal tumors in the horseshoe kidney (HSK) is clinically challenging due to malformations and complex blood supply. Herein, we present two cases of RAPN in patients with HSK treated using selective artery clamping methods. A 61-year-old male with a 15 mm renal tumor located on the upper pole of the right HSK was referred to our Department. The patient underwent RAPN via the transperitoneal approach, following a three-dimensional computed tomography (3D-CT) assessment. Additionally, before surgery, we confirmed which renal arteries would be clamped in surgery by examining the kidney regions supplied by each renal artery. The second patient referred to our Department, a 45-year-old male, had a 46 mm renal tumor located on the isthmus of the HSK. His tumor received blood supply from two renal arteries, with the bilateral collecting systems converging and forming a ureter on 3D-CT. The patient underwent RAPN through an intraperitoneal approach in the semi-lateral position, with port placement lower than in standard RAPN. Pathological examinations revealed clear-cell renal cell carcinoma with negative surgical margins in both cases. Both patients had no recurrences or metastases at 53 and 13 months post-surgery, respectively. We present cases successfully treated with RAPN with selective artery clamping methods for HSK using 3D-CT without encountering complications, even in isthmus tumors.

Objective To describe our renal sinus anatomy based tension-free reconstruction step by step and report perioperative data and long-term outcomes of patients undergoing robot-assisted nephron-sparing surgery for hilar tumors. Methods From June 2013 to December 2016, data of 286 consecutive patients with hilar tumor who underwent RAPN in single center were retrospectively reviewed.There were 202 males and 84 females, aged(56.2±9.2)years.The body mass index was(26.8±3.5)kg/m2.The median diameter of tumor was 2.6 cm(0.8-6.0 cm), and R. E.N.A.L.score was 8.2±1.8. The anatomy-based Garland specialized in protecting the large hilar vessels and minimizing the tension of trans/retroperitoneal defect suturing approach for anterior/posterior lip hilar tumor respectively. Patient′s perioperative complications and long-term follow-up including renal function and oncological outcomes were analyzed. Results Garland technique was successfully applied in 284 patients, the warm ischemia time (WIT) was (18.2±4.1) min. Median estimated blood loss (EBL) for RAPN was 100 ml (range: 10-600 ml). Median operative time was 120 min (range: 60-230 min). No patient was converted to open surgery. Postoperative hospital stay was 4.0 d (range: 2.0-9.0 d). Three patients (1.1%) had positive surgical margins. Of all the pathological results, 260 cases (91.5%)were clear renal cell carcinoma, 8 cases (2.8%)were chromophobe renal carcinoma, 7 cases (2.5%)were papillary type renal cell carcinoma, 5 cases(1.8%) were oncocytoma, 3 cases (1.1%)were angiomyolipoma, one case (0.3%)was mucinous tubular and spindle cell carcinoma. Two patients underwent blood transfusion. Three patients(1.0%) had local recurrence.284 patients were alive at a median follow-up of 36 months (range: 12-54 months). Conclusions Garland technique is safe and feasible for hilar tumor resection and reconstruction with less surgical complications. Large renal vessel injury was avoided and tension of wound closure was minimized. The trans/retroperitoneal approaches are capable for anterior/posterior hilar tumor. Patients with hilar tumor could benefit from robotic surgery with a well preserved renal function and good oncological outcomes. Key words: Kidney neoplasms, renal hilum; Robot; Nephron-sparing surgery; Renal sinus anatomy; Kidney reconstruction

Objective: To elucidate the role of PDCD4 in renal cell carcinoma, especially in clear cell renal cell carcinoma (KIRC), preliminarily analyze the effect of PDCD4 on the survival and prognosis of patients with renal cell carcinoma, further analyze the specific mechanism, and evaluate the value of PDCD4 as a potential biomarker of renal cell carcinoma. Methods: The online database was used to analyze the tumor suppressor effect of PDCD4 in renal clear cell carcinoma, and the mechanism of PDCD4 in the occurrence and development of renal cell carcinoma was comprehensively sorted out combined with literature review. Results: The expression of PDCD4 was low in renal cell carcinoma, and was correlated with lymph node metastasis, grade and stage of renal cell carcinoma, especially in clear cell renal cell carcinoma (P<0.05). The expression of PDCD4 in renal clear cell carcinoma was also related to immune infiltrating cells, and its high expression enhanced immunity (P<0.05). The survival prognosis of patients with renal clear cell carcinoma with low expression was worse (P<0.05). Conclusions: As a tumor suppressor gene, PDCD4 plays an important role in the occurrence and development of renal cell carcinoma through various mechanisms. Pdcd4 may be used as a biomarker for predicting the occurrence and development of renal cell carcinoma, especially for clear cell renal cell carcinoma, to assist in early diagnosis and treatment and predict prognosis.

Solid Renal Masses in Transplanted Allograft Kidneys: A Closer Look at the Epidemiology and Management.

Renal cell carcinoma in horseshoe kidney treated with retroperitoneoscopic partial nephrectomy: A case report.

Renal cell carcinoma in a horseshoe kidney: A case report.

Reporting Standards for Percutaneous Thermal Ablation of Renal Cell Carcinoma