IJCEMR
“Nephron sparing surgery” in a tumor greater than 7 cm
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Abstract
Introduction: We present a case of nephron sparing surgery (NSS), of a patient,68 years old, resident in e Prizren, who had a tumor bigger than 7 (8.5 cm), meaning T2a staging tumor. Renal cell carcinoma (RCC) is a common malignancy with an increasing incidence. NSS was proven feasible decades ago for patients with imperative indications to preserve maximum kidney function, for instance solitary kidney, bilateral renal tumors, or moderate/severe chronic kidney disease (ChKD). Purpose: The goal of partial nephrectomy is complete excision of potentially malignant tissue without malignant cells at the border of the surgical specimen, with maximum preservation of nearby normal renal parenchyma. It is known that nephron sparing surgery is preferred for T1a and T1b, or when the tumor is limited in kidneys and not greater than 7 cm. In this case, the tumor has passed T1 staging, it belonged to T2 staging .We succeeded doing the “nephron sparing surgery”, saving less than half of the kidney. Result: The approach to a SRM (small renal masses) is based on tumor size, stage, and location. Most NSS requires renal vessel occlusion during the excision, and renal tubular tissue is particularly sensitive to ischemia; the WIT (warm ischemia time), therefore, should be minimized. Damage to renal tubular tissue is directly related to WIT. Although the upper limit of WIT is debatable, a limit of 20 minutes is a generally accepted guideline. The kidney can be approached with traditional “open” surgery or laparoscopically. For SRMs appropriate for NSS, open partial nephrectomy represents the gold standard. This approach has the most data regarding oncologic and renal function outcomes, with long-term cancer-specific survival rates exceeding 90%. Conclusion: We can conclude that “nephron sparing surgery” in specific cases can be used also for patients with T2a staging tumor, for those patients were there is hope that they can benefit from this procedure. The patient has stayed in our clinic for ten days, and is released in a good health condition, unfortunately the remaining renal parenchyma was not sufficient to perform its function, because of the chronic pyelonephritis with an emphasized hypoplasia of the other kidney (left kidney). So the only benefit of this procedure in this patient was that instead of doing the dialysis three times a week, he could do it two times a week.
References
[1] Lipworth L Tarone R E McLaughlin J K The epidemiology of renal cell carcinoma J Urol 2006176(6 Pt 1):2353–2358. [PubMed].
[2] Lane B R Novick A C Nephron-sparing surgery BJU Int 200799(5 Pt B, 5b):1245–1250. [PubMed].
[3] Fergany A F, Hafez K S, Novick A C. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol. 2000;163(2):442-445. [PubMed].
[4] Znaor A, Lortet-Tieulent J, Laversanne M, Jemal A, Bray F. International variations and trends in renal cell carcinoma inc idents and mortality; European Urology 2015, 67, 519-530.
[5] Kane CJ, Mallin K, Ritchey J, Cooperberg MR, Carroll PR. Renal cell cancer stage migration: analysis of the national cancer database; Cancer 2008, 113, 78-83.
[6] Weight CJ, Larson BT, Fergany AF et al. Nephrectomy induced chronic renal insufficiency associated with increased risk of car diovascular death and deaths from any cause in patients with localized cT1b renal masses. Journal of Urology, 183, 1317-1323, 2010.
[7] Thompson RH, Boorjian SA, Lohse CM et al. Radical nephrectomy for pT1a renal masses may be associated with the increased overall survival compared with partial nephrectomy. Journal of Urology 179, 468-471, 2008.
[8] Van Poppel H, Da Pozzo L, Albrecht W et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. European Urology, 59, 543-552, 2011.
[9] Ljunberg B, Bensalah K, Canfield S, et al. Guidelines on renal cell carcinoma updated 2014. European Urology 67 (5), 913-924, 2015.
[10] Van Poppel H. Efficacy and safety of nephron-sparing surgery. International Journal of Urology 17 (4), 314-326, 2010.
[11] Van Poppel H, Claes H, Willemen P , Oyen R, Baert L. Is there a place for conservative surgery in the treatment of renal carcinoma? British Journal of Urology, 67 (2), 129-133, 1991.
[12] Vermooten V. Indications for conservative surgery in certain renal tumors: a study base d on growth pattern of the cell carc inoma. Journal of Uology, 64, 200-206, 1950.
[13] Bazeed MA, Schärfe T, Becht E, Jurincic C, Alken P, Thüroff JA. Conservative surgery of renal cell carcinoma. European Urology 12 (4), 238-243, 1986.
[14] Van Poppel H. NSS in rena l carcinoma. Brazilian Journal of Urology 26 (4), 342-353, 2000.
[15] Danzig MR, Ghandour RA, Chang P, Wagner AA, P ierorazio PM, Allaf ME, McKiernan JM. Active surveillance is superior to radical nephrectomy and equivalent to partial nephrectomy for preserving renal function in patients with small renal masses: results from the DISSRM registry. Journal of Urology, 194, 903-909, 2015.
[16] Carini M, Minervini A, Masieri L, Lapini A, Serni S. Simple enucleation for the treatment of PT1a renal cell carcinoma: our 20-year experience. European urology, 50 (6), 1267-1271, 2006.
[17] Blum KA, Paulucci DJ, Abaza R, Eun DD, Bhandari A, Delto JC, Krane LS, Hemal AK, Badani KK. Main renal artery clamping with or without renal vein clamping during robotic partial nephrectomy for clinical T1 renal masses: perioperative and long-term functional outcomes. Urology, 97, 118-123, 2016.
[18] Power NE, Maschino AC, Savage C, Silberstein JL, Thorner D, Tarin T, Wong A, Touijer KA, Russo P, Coleman JA. I ntraoperative mannitol use does not improve long-term renal function outcomes after minimally invasive partial nephrectomy. Urology, 79 (4), 821-825, 2012.
[19] Carini M, Minervini A, Masieri L, Lapini A, Serni S. Simple enucleation for the treatment of PT1a renal cell carcinoma: our 20-year experience. European urology, 50 (6), 1267-1271, 2006.
[20] Minervini A, Campi R, Sessa F, Derweesh I, Kaouk JH, Mari A, Rha KH, Sessa M, Volpe A, Carini M, Uzzo RG. Positive surgical margins and local recurrence after simple enucleation and standard partial nephrectomy for malignant renal tumors: systematic review of the literature and metaanalysis of prevalence. Minerva Urology Nefrology, 2017 Jan 26, doi: 10.23736/S0393-2249.17.02864-8.
How to cite this paper
“Nephron sparing surgery” in a tumor greater than 7 cm
How to cite this paper: Isa Haxhiu, Xhedet Çuni, Emirjon Haxhiu, Rexhep Kasumaj, Rinor Haxhiu, Salih Krasniqi, Besnik Elshani, Anduenë Haxhiu. (2018) “Nephron sparing surgery” in a tumor greater than 7 cm. International Journal of Clinical and Experimental Medicine Research, 2(1), 22-28.
DOI: http://dx.doi.org/10.26855/ijcemr.2018.01.001
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