Radical Nephrectomy For Renal Carcinoma Research Articles

Laparoscopic Radical Nephrectomy for Renal Carcinoma with Known Level I Renal Vein Tumor Thrombus

Laparoscopic nephrectomy in patients with known venous involvement is an emerging technique. The goal of this study was to describe our experience and outcomes with laparoscopic nephrectomy for patients with preoperatively diagnosed level I (renal vein) tumor thrombus. The data from all patients undergoing laparoscopic nephrectomy by one surgeon from July 1, 2004 to February 28, 2006 were reviewed. The patients with a preoperatively diagnosed tumor thrombus were included in the study. A pure laparoscopic transperitoneal technique was used with intraoperative ultrasonography to ensure complete removal of the thrombus. The medical records were reviewed for clinical, operative, and follow-up information. Five patients were identified. The mean age, American Society of Anesthesiologists score, and tumor size were 59.8 years (range 34 to 81), 2.6 (range 2 to 3), and 5.5 cm (range 4 to 6), respectively. The mean operative time and estimated blood loss were 119.6 minutes (range 92 to 180) and 150 mL (range 50 to 300), respectively. The mean hospital stay was 3.6 days (range 2 to 4), and no complications occurred. The final stage was T3b with negative margins in all cases. The mean Fuhrman grade was 2.4 (range 2 to 3). Two patients had known metastases and underwent cytoreductive nephrectomy. These 2 patients were alive at a mean follow-up of 11.5 months. Of the other 3 patients, at a mean follow-up of 8.7 months, 2 had no evidence of disease, and 1 had developed recurrence in the liver and was treated with sorafenib, resulting in tumor regression. Pure laparoscopic transperitoneal nephrectomy for patients with preoperatively diagnosed level I tumor thrombus is safe and effective in experienced hands. Additional series are needed to examine the long-term oncologic outcomes.

Carcinoma renal metastásico a peritoneo: A propósito de un caso

We describe the case of a young male presenting with non-specific abdominal symptoms on follow-up after radical nephrectomy for renal carcinoma leading to the finding of local recurrence and peritoneal metastases. A second exploratory laparotomy was carried out for tumor reduction, but it was followed by fast peritoneal recurrence. Despite the treatment with alpha interferon, three months later he developed multiple hepatic metastases. Peritoneal involvement by renal cell carcinoma is rare and implies a bad prognosis.

HAND ASSISTED LAPAROSCOPIC RADICAL NEPHRECTOMY FOR RENAL CARCINOMA USING A NEW ABDOMINAL WALL SEALING DEVICE

We report our initial experience with a hand assisted laparoscopic radical nephrectomy for patients with renal carcinoma, and compare our results to those of conventional open radical nephrectomy. The clinical data on 6 consecutive patients who underwent hand assisted laparoscopic radical nephrectomy for stage T1N0M0 renal cell carcinoma were reviewed. We performed hand assisted laparoscopic surgery using the new LAP DISC* abdominal wall sealing device. We compared the results of this procedure with those of conventional open radical nephrectomy in 12 patients with stage T1N0M0 renal cell carcinoma. The hand assisted laparoscopic radical nephrectomy for renal carcinoma was successfully performed without any major or minor complications in all 6 patients. Mean operation time for the laparoscopic group was significantly longer than that for the open surgery group (303 minutes versus 224 minutes, p = 0.0042). However, no significant difference was observed in mean estimated blood loss for the 2 groups (264 ml. in the laparoscopic group versus 341 ml. in the open surgery group). The frequency of parenteral analgesia postoperatively in the laparoscopic group was significantly lower than that in the open surgery group (16.7% versus 75.0%, p = 0.043). In addition, the laparoscopic group seemed to recover more rapidly than the open surgery group. The abdominal wall sealing device was easy to attach to the abdominal wall, and allowed rapid hand removal and reinsertion. Our preliminary results indicate that a hand assisted laparoscopic radical nephrectomy with the abdominal wall sealing device is an effective and safe surgical procedure, and is less invasive than open radical nephrectomy.

COMPLETE RADICAL NEPHRECTOMY AND VENA CAVAL THROMBECTOMY DURING CIRCULATORY ARREST

A modification of radical nephrectomy for renal carcinoma and vena caval tumor thrombectomy for supradiaphragmatic tumor extension under hypothermic circulatory arrest is presented. Nephrectomy was performed during the circulatory arrest time in 16 consecutive patients during the last 4 years. Average hypothermic circulatory arrest time increased by 6 minutes. By elimination of manipulation of tumor and thrombus before circulatory arrest potential thrombus fragmentation and embolization were minimized. There were no significant differences in blood loss or complications compared to a prior series of 10 patients undergoing the procedure using conventional techniques. Performance of complete radical nephrectomy along with venal caval embolectomy during circulatory arrest increases the safety of the procedure without significant morbidity.

Ultrasound in Renal Carcinoma: An Essential in Follow‐up

A total of 115 patients underwent radical nephrectomy for renal carcinoma in this hospital between 1983 and 1990. Follow-up was available in 113 cases (mean 27 months, range 0-93). The overall actuarial survival was 66% at 2 years and 53% at 5 years. Fifty-three patients have been followed up with annual abdominal ultrasound over the last 2 years. Abnormal ultrasound scans were reported in 6 patients (11%) on follow-up. Two had para-aortic lymph node recurrence amenable to further surgery. One patient developed a metachronous tumour and a partial nephrectomy was carried out. Three patients had local recurrence not amenable to further surgery. Ultrasound and computed tomography have found an invaluable place in the pre-operative diagnosis and staging of renal carcinoma. Sixteen of 113 tumours were diagnosed by ultrasound or intravenous urography carried out for some other purpose; 8 were less than 5 cm in diameter and 12 were T category N0M0V0. The 2-year survival rate in this group was 85% (mean 30 months, range 19-67). We consider the routine follow-up of renal carcinoma with clinical examination and annual chest X-ray to be inadequate. The application of ultrasound in the follow-up of these patients has provided a valuable adjunct to our clinical practice. It has allowed the prompt diagnosis of lymph node recurrence or metachronous tumour amenable to secondary surgery with the potential for improved survival in this group of patients. We consider this to be the logical extension of the value of ultrasound in the pre-operative diagnosis of renal carcinoma.