Related Experiment Videos
Failed partial nephrectomy: local recurrence vs. multicentric disease
1Department of Urology, University of Florida Medical Center, Gainesville.
Abstract:
Candidates for partial nephrectomy for renal cell carcinoma include those with (1) bilateral synchronous lesions, (2) tumour in a solitary kidney and (3) renal mass and borderline renal function. Present imaging techniques aid in the identification of appropriate candidates for partial nephrectomy and in the preoperative assessment for technical feasibility of the operation. Studies have shown that the postoperative local recurrence rate ranges from 9 to 13%. We submit a case report in which a 65-year-old male with a history of colon carcinoma four years earlier was found to have a 3 cm left lower pole lesion on his follow-up abdominal CT scan. Upon intended partial nephrectomy, a small synchronous upper pole mass was noticed as well as numerous cortical lesions despite extensive preoperative imaging to the contrary. It is our feeling that finer imaging techniques including thinner CT cuts, additional imaging planes and continued use of renal ultrasound will aid in the identification of ipsilateral, synchronous lesions and draw further distinction between local recurrence and multicentric disease.
Insights
Partial nephrectomy is suitable for specific renal cell carcinoma cases. Advanced imaging is crucial for identifying synchronous lesions and distinguishing recurrence from multicentric disease.
Area of Science:
- Urology
- Oncology
- Radiology
Background:
- Partial nephrectomy is a standard treatment for renal cell carcinoma (RCC) in patients with specific indications.
- Preoperative imaging is essential for candidate selection and surgical planning.
- Reported local recurrence rates after partial nephrectomy range from 9% to 13%.
Observation:
- A 65-year-old male with a history of colon carcinoma presented with a 3 cm left lower pole renal mass.
- During planned partial nephrectomy, unexpected synchronous ipsilateral upper pole and numerous cortical lesions were discovered.
- These findings contrasted with extensive preoperative imaging assessments.
Findings:
- Preoperative imaging may underestimate the extent of synchronous renal masses.
- Advanced imaging techniques, including thinner CT slices and additional planes, are necessary.
- Integrating renal ultrasound can improve the detection of ipsilateral synchronous lesions.
Implications:
- Enhanced imaging protocols are needed for accurate preoperative assessment in partial nephrectomy candidates.
- Improved detection of multicentric disease can refine surgical planning and patient management.
- This case highlights the importance of meticulous intraoperative inspection and advanced imaging for RCC.