Nephrectomy in the management of metastatic osteosarcoma

This report discusses a rare case of nephrectomy for metastatic osteosarcoma, the first performed laparoscopically, and proposes such management as a standard of care. A 21-year-old woman with a history of metastatic osteosarcoma involving her right kidney was referred to our institution for evaluation. She was managed with a hand-assisted laparoscopic nephrectomy. An exhaustive review of the English literature pertaining to this disease was performed. To our knowledge, this case represents only the sixth nephrectomy ever reported for metastatic osteosarcoma and the first performed by a laparoscopic approach. In addition, this is the first reported case of this disease invading the renal vein. The literature suggests that the incidence of renal involvement in osteosarcoma is significant and that renal imaging should be mandatory in such patients. When renal metastases are diagnosed, prompt nephrectomy is warranted. A minimally invasive approach in these patients should be considered.