Surgical enucleation for the treatment of renal tumors
Michael E Franks1, Ronald L Hrebinko, Badrinath R Konety
1Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Introduction:
We analyzed our institutional experience with surgical enucleation for the primary treatment of small renal tumors.
Materials And Methods:
Patient demographics, histological features, effect of different types of vascular control and outcome from surgery were analyzed in 45 patients. A majority of the tumors (67%) were diagnosed incidentally.
Results:
All were stage T(1), 77% were low grade (I-II) and 23% were high grade (III-IV). Complication occurred in 12% of patients. At a mean follow-up of 34 months (range 7-97), 28 of 33 patients (84%) with malignant tumors were alive without evidence of disease. One patient with a solitary kidney developed recurrent tumor after enucleation that required nephrectomy. Mean operative time was significantly lower with the compression technique versus direct vascular control (164 +/- 12 min vs. 233 +/- 15 min, p = 0.002). There were no differences in outcome between the two techniques.
Conclusions:
Surgical enucleation is a safe and viable procedure for the treatment of small renal tumors. Manual compression of the kidney appears to be at least as effective as clamping of the renal vessels in obtaining vascular control during the procedure and is more expeditious.
Insights
Surgical enucleation is a safe treatment for small renal tumors. Manual kidney compression is as effective as vascular clamping but faster, reducing operative time.
Area of Science:
- Urology
- Surgical Oncology
Background:
- Analyzed institutional experience with surgical enucleation for primary treatment of small renal tumors.
- 67% of tumors were incidentally diagnosed.
Purpose of the Study:
- Evaluate the safety and efficacy of surgical enucleation for small renal tumors.
- Compare outcomes and operative times between manual kidney compression and direct vascular clamping for vascular control.
Main Methods:
- Retrospective analysis of 45 patients undergoing surgical enucleation.
- Evaluation of patient demographics, tumor histology, vascular control methods, and surgical outcomes.
- Comparison of operative times and complications between manual compression and direct vascular clamping.
Main Results:
- All tumors were stage T1; 77% were low grade (I-II), 23% high grade (III-IV).
- Complications occurred in 12% of patients. At 34 months follow-up, 84% of patients with malignant tumors were alive without evidence of disease.
- Mean operative time was significantly lower with manual compression (164 min) vs. direct vascular control (233 min) (p=0.002), with no difference in outcome.
Conclusions:
- Surgical enucleation is a safe and viable procedure for treating small renal tumors.
- Manual kidney compression is an effective and more expeditious method for vascular control compared to clamping renal vessels.
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
01:26Kidney Transplant II: Surgical Procedure
01:28Urologic Endoscopic Procedure: Cystoscopic Examination