Limits...
Laparoscopic nephrectomy, ex vivo partial nephrectomy, and autotransplantation for the treatment of complex renal masses.

Nayak JG, Koulack J, McGregor TB - Case Rep Urol (2014)

Bottom Line: Final pathology confirmed pT1, clear cell renal cell carcinoma with negative margins in all.All are disease free at up to 39 months follow-up with stable renal function.In conclusion, the described approach remains a viable option for the treatment of complex renal masses preserving oncological control and renal function.

View Article: PubMed Central - PubMed

Affiliation: Section of Urology, University of Manitoba, Z3013-409 Taché Avenue, Winnipeg, MB, Canada R2H 2A6 ; Department of Urology, University of Washington, BB1121-1959 NE Pacific Street, Seattle, WA 98195, USA.

ABSTRACT
In the contemporary era of minimally invasive surgery, very few T1/T2 renal lesions are not amenable to nephron-sparing surgery. However, centrally located lesions continue to pose a clinical dilemma. We sought to describe our local experience with three cases of laparoscopic nephrectomy, ex vivo partial nephrectomy, and autotransplantation. Laparoscopic donor nephrectomy was performed followed by immediate renal cooling and perfusion with isotonic solution. Back-table partial nephrectomy, renorrhaphy, and autotransplantation were then performed. Mean warm ischemia (WIT) and cold ischemic times (CIT) were 2 and 39 minutes, respectively. Average blood loss was 267 mL. All patients preserved their renal function postoperatively. Final pathology confirmed pT1, clear cell renal cell carcinoma with negative margins in all. All are disease free at up to 39 months follow-up with stable renal function. In conclusion, the described approach remains a viable option for the treatment of complex renal masses preserving oncological control and renal function.

No MeSH data available.


Related in: MedlinePlus

Axial and coronal infused CT imaging of patient 3.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4260371&req=5

fig2: Axial and coronal infused CT imaging of patient 3.

Mentions: Patient 1 was a 56-year-old male who was found to have bilateral renal masses with a 17 cm left renal mass and a 4 cm, centrally located right renal mass. The patient successfully underwent a left laparoscopic nephrectomy leaving him with a central renal mass in his solitary right kidney (Figure 1). Preoperative renal function demonstrated a serum creatinine of 116 μmol/L; GFR 101.6 mL/min. Patient 2 is a 76-year-old female with a history of stage IV chronic kidney disease that presented with a centrally located mass in her solitary functioning kidney. Patient 3 is a 75-year-old female with significant comorbidities including stage IIIb chronic kidney disease that presented with an incidental centrally located renal mass (Figure 2). The R.E.N.A.L. (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines) nephrotomy scores [5] were 10 h, 11 h, and 10 h for patients 1–3, respectively.


Laparoscopic nephrectomy, ex vivo partial nephrectomy, and autotransplantation for the treatment of complex renal masses.

Nayak JG, Koulack J, McGregor TB - Case Rep Urol (2014)

Axial and coronal infused CT imaging of patient 3.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4260371&req=5

fig2: Axial and coronal infused CT imaging of patient 3.
Mentions: Patient 1 was a 56-year-old male who was found to have bilateral renal masses with a 17 cm left renal mass and a 4 cm, centrally located right renal mass. The patient successfully underwent a left laparoscopic nephrectomy leaving him with a central renal mass in his solitary right kidney (Figure 1). Preoperative renal function demonstrated a serum creatinine of 116 μmol/L; GFR 101.6 mL/min. Patient 2 is a 76-year-old female with a history of stage IV chronic kidney disease that presented with a centrally located mass in her solitary functioning kidney. Patient 3 is a 75-year-old female with significant comorbidities including stage IIIb chronic kidney disease that presented with an incidental centrally located renal mass (Figure 2). The R.E.N.A.L. (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines) nephrotomy scores [5] were 10 h, 11 h, and 10 h for patients 1–3, respectively.

Bottom Line: Final pathology confirmed pT1, clear cell renal cell carcinoma with negative margins in all.All are disease free at up to 39 months follow-up with stable renal function.In conclusion, the described approach remains a viable option for the treatment of complex renal masses preserving oncological control and renal function.

View Article: PubMed Central - PubMed

Affiliation: Section of Urology, University of Manitoba, Z3013-409 Taché Avenue, Winnipeg, MB, Canada R2H 2A6 ; Department of Urology, University of Washington, BB1121-1959 NE Pacific Street, Seattle, WA 98195, USA.

ABSTRACT
In the contemporary era of minimally invasive surgery, very few T1/T2 renal lesions are not amenable to nephron-sparing surgery. However, centrally located lesions continue to pose a clinical dilemma. We sought to describe our local experience with three cases of laparoscopic nephrectomy, ex vivo partial nephrectomy, and autotransplantation. Laparoscopic donor nephrectomy was performed followed by immediate renal cooling and perfusion with isotonic solution. Back-table partial nephrectomy, renorrhaphy, and autotransplantation were then performed. Mean warm ischemia (WIT) and cold ischemic times (CIT) were 2 and 39 minutes, respectively. Average blood loss was 267 mL. All patients preserved their renal function postoperatively. Final pathology confirmed pT1, clear cell renal cell carcinoma with negative margins in all. All are disease free at up to 39 months follow-up with stable renal function. In conclusion, the described approach remains a viable option for the treatment of complex renal masses preserving oncological control and renal function.

No MeSH data available.


Related in: MedlinePlus