1324 Open Partial Nephrectomy for Renal Cell Carcinoma

Open partial nephrectomy, or nephron-sparing surgery (NSS), is now considered as the standard for small renal tumors treatment. The oncologic efficacy and safety of NSS for the treatment of stage-T1a renal tumors have been repeatedly demonstrated to be equivalent to radical nephrectomy. A 66-year-old gentleman chronic smoker was incidentally found to have a small mid pole lesion in the left kidney on routine ultrasound scan, CT finding was 2x2 cm mid pole tumor, no involvement or metastasis, the patient given the option of partial nephrectomy. In surgery, the left kidney was explored, and the tumor mass was seen to occupy the mid pole. The mid pole branch of the renal artery was clamped after cooling the kidney with ice slush following 300cc of 20% mannitol infusion. In-situ nephron-sparing left nephrectomy was done with a margin of 1cm minor upper calyceal injury repaired. The patient was discharged five days postoperative. Gross examination of the specimen revealed a wedge biopsy of the mid pole with attached perinephric fat with swelling part at the outer surface, pushing the capsule. Microscopic sections show a well-defined tumor mass in the renal parenchyma, surrounded by a fibrous capsule, composed of a multilocular cystic area lined by malignant cells. NSS initially was reserved for patients with solitary kidneys, tumors, and those with significant comorbidities predisposing to future renal failure; indications have expanded recently to allow elective partial nephrectomy in the setting of a normal contralateral kidney.