Limits of nephron sparing surgery in renal tumors – tenfold partial nephrectomy in solitary kidney

Czech version

Authors: Petr Macek ^1,2; Libor Zámečník ²; Tomáš Hanuš ²
Authors‘ workplace: Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France ¹; Urologická klinika 1. LF UK a VFN v Praze ²
Published in: Ces Urol 2019; 23(3): 243-249
Category: Case report

Overview

Multifocal renal tumors are not frequent, but they do not need to lead to nephrectomy automatically. We present a case of a 60-year old male with right solitary kidney (left sided nephrectomy for renal cancer), who has had a CT diagnosis of 10 areas on the kidney with solid renal masses (but some included more lesions). Following an extensive discussion about possible options and the risks of surgical management, a 10-fold open partial nephrectomy was carried out. The largest tumor was resected first under cold ischemia of 17 mins and the remaining with no ischemia. Length of surgery was 250 minutes with no perioperative complications. There were no postoperative surgical complications. However renal function deteriorated substantially and nephrological pharmacological intervention for hyperkalemia and metabolic acidosis, but no dialysis was necessary. Histology showed 13 lesions of clear cell renal carcinoma G3, size 5 to 35 mm. Follow‑up CT 1-year post‑op showed one lesions of uncertain significance, which will be further observed. Renal function is stable with creatinine below 200 μmol/l.

Keywords:

Multifocal renal tumor – multiple partial nephrectomy – individualized management

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