V01-07 A RARE CASE OF PT3A CLEAR CELL RENAL CELL CARCINOMA IN A BIFID KIDNEY TREATED WITH ROBOTIC HEMINEPHRECTOMY

Abstract

INTRODUCTION AND OBJECTIVE: Bifid, or divided-shaped kidney is relatively rare, with a reported incidence of 4%, of which 42% also demonstrate collecting system duplication. Malignant neoplasm accompanied by ureteral duplication is extremely rare with 24 cases reported in the literature. The majority of these reports were of urothelial carcinoma, and one case reported in the literature of a bifid kidney with papillary carcinoma. Here we present a case of a 42 year-old Hispanic female with the finding of a renal cell carcinoma involving only the upper pole of a bifid kidney with a completely duplicated collecting system. METHODS: The patient underwent a robotic-assisted laparoscopic left hemi-nephrectomy of the upper pole moiety of a bifid left kidney, with pathologic analysis demonstrating a 7.2 x 6.3 x 5.1cm clear cell renal cell carcinoma with invasion into a segmental branch of the renal vein. Intraoperative ultrasound was critical in the identification of the inferior border of the lesion to ensure complete excision along the isthmus dividing the upper and lower pole moieties. Indocyanine green was used to demonstrate re-perfusion and drainage of the remaining lower moiety of the bifid kidney at the completion of the procedure. RESULTS: There were no intraoperative or postoperative complications. Total robotic console time was 162 minutes. The intraoperative estimated blood loss was 400ml. Warm ischemia time was under 30 minutes. The patient was discharged home on postoperative day 2. Pre and post-operative eGFR were identical. Final pathologic analysis demonstrated a pT3a Fuhrman Grade 1 clear cell renal cell carcinoma with negative margins. CONCLUSIONS: Renal cell carcinoma of a bifid kidney with a duplicated collecting system is extremely rare. Here we demonstrate that a minimally invasive nephron sparing approach may be safely utilized in these cases. Pre-operative CT angiogram may be used in these cases delineate aberrant anatomy to minimize ischemia further. Further follow up to ensure oncologic outcome similar to partial nephrectomy in pT3a renal cell tumors will be necessary.Source of Funding: none