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Surgical treatment of stage pT3b renal cell carcinoma in solitary kidneys: a case series
Author(s) -
Sengupta Shomik,
Zincke Horst,
Leibovich Bradley C.,
Blute Michael L.
Publication year - 2005
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2005.05566.x
Subject(s) - medicine , nephrectomy , renal cell carcinoma , renal vein , stage (stratigraphy) , kidney cancer , surgery , kidney disease , kidney , dialysis , nephrology , urology , radiology , paleontology , biology
OBJECTIVE To describe the surgical management of patients with renal cell carcinoma (RCC) in a solitary kidney (managed preferentially by nephron‐sparing surgery, NSS, to avoid dialysis) and extending into the renal vein or inferior vena cava (T3b). PATIENTS AND METHODS We identified 13 patients treated surgically between 1977 and 2002 for stage T3b RCC in a solitary kidney; their charts were reviewed to ascertain details of management, pathology and outcomes. RESULTS NSS was successful in seven patients (four in situ and three extracorporeally). Five patients had radical nephrectomy (RN), four after failed NSS. The mean ( sem ) operative duration was longer for NSS, at 5.8 (0.7) h, than RN, at 3.3 (0.6) h. There was one death during surgery before nephrectomy, and eight other complications in six patients. At a median (range) follow‐up of 24 (0–204) months, eight patients had died, four from RCC (all having had NSS) at a median interval of 9.5 (7–16) months. Of the five patients alive at a median follow‐up of 25 months, four had no identifiable disease, whilst one had systemic recurrence. CONCLUSIONS NSS combined with venous tumour thrombectomy for treating T3b RCC involving a solitary kidney is feasible, albeit complicated. There was oncological success in a third of the patients. The treatment of these patients needs to be individualized, as alternatives to NSS (RN or observation) have obvious disadvantages.