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[Nephron-sparing treatment of kidney neoplasms in transplanted kidney. Our experience]
F Lasaponara1, M Catti, C Ferraris
1Dipartimento di Nefro-Urologia, UOA Urologia, ASO San Giovanni Battista, Torino.
Background:
To evaluate survival rate, follow-up and renal function in patients treated with "nephron-sparing" approach due to cancer in a transplanted kidney.
Methods:
During the 18 years' activity of our Transplantation Centre 3 renal carcinomas in transplanted kidneys (0.24%) have been found. Diagnoses were made in one case during transplantation procedures and, in the remaining two, 1 month and 10 years after. All tumours were unifocal, small (10, 12 and 18 mm of diameter), capsulated and low stage (T1). The resection of the mass ("nephron-sparing" surgery) and of a layer (1 cm thick) of the tissue surrounding the tumour was performed. The histological exam showed in all cases low grade (G2) renal cell carcinoma and negative surgical margins.
Results:
138, 94 and 15 months after transplant all patients are alive, without disease recurrence and with good renal function. In all cases the doses of immune-suppressive therapy were reduced.
Conclusions:
Renal cancer in transplanted kidneys is generally treated with nephrectomy. On the contrary, we decided to apply the same criteria which are accepted for the treatment of renal neoplasms in general and then to perform a "nephron-sparing" surgery when the tumour is small, capsulated and with negative surgical margins at the intraoperative histological exam. In personal experience good results from the oncologic and nephrologic point of view have been accomplished.
Insights
Nephron-sparing surgery for small renal tumors in transplanted kidneys offers excellent oncologic and renal function outcomes. This approach preserves kidney health and prevents disease recurrence in transplant recipients.
Area of Science:
- Nephrology
- Oncology
- Transplantation Surgery
Context:
- Renal cancer in transplanted kidneys is rare but requires careful management.
- Traditional treatment often involves nephrectomy, potentially compromising graft function.
- Evaluating alternative, kidney-sparing approaches is crucial for long-term patient outcomes.
Purpose:
- To assess the efficacy of nephron-sparing surgery for renal cell carcinoma in transplanted kidneys.
- To evaluate patient survival, disease recurrence, and graft renal function post-surgery.
- To determine if oncologic and nephrologic goals can be achieved with this conservative approach.
Summary:
- Three cases of small, low-stage renal cell carcinoma in transplanted kidneys were treated with nephron-sparing surgery.
- All patients demonstrated long-term survival, no disease recurrence, and preserved renal function.
- Surgical margins were negative, and immunosuppressive therapy doses were reduced post-operatively.
Impact:
- Nephron-sparing surgery is a viable and effective option for selected renal tumors in transplanted kidneys.
- This approach can achieve favorable oncologic control while preserving crucial renal function.
- Findings support adapting general renal neoplasm treatment criteria to kidney transplant recipients.