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Potential underdetection of pT(3a) renal-cell carcinoma with laparoscopic morcellation
Candace F Granberg1, Amy E Krambeck, Bradley C Leibovich
1Department of Urology, Mayo Medical School, Mayo Clinic, Rochester, Minnesota 55905, USA.
Background And Purpose:
After tumor morcellation, staging relies on clinical imaging. Our goal was to determine the size distribution of stage pT(3a) renal-cell carcinomas (RCCs) and whether evidence of extrarenal invasion is present on preoperative imaging.
Patients And Methods:
We selected patients with organ-confined RCC treated surgically from 1975 to 2002 and subsequently found to have stage pT(3a) disease. Preoperative radiologic imaging reports were reviewed for evidence of extrarenal tumor extension.
Results:
Of the 1781 patients treated surgically for pM(0) RCC, 129 (7.2%) had pT(3a) disease. Tumor size distributions were: 17 (13.2%) < or =4 cm, 38 (29.5%) >4 cm but < or =7 cm, and 74 (57.4%) >7cm. There were 6 patients (4.7%) with extrarenal extension according to preoperative imaging. Of these, 2 (5.3%) had tumors >4 cm but < or =7cm, and 4 (5.4%) had tumors >7 cm.
Conclusion:
Many pT(3a) tumors are small, and the majority is understaged clinically. Thus, morcellation in these patients would prevent accurate staging.
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