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Published on: July 3, 2013
Nephron-sparing surgery for giant angiomyolipomas of kidney
Giampaolo Siena1, Andrea Minervini, Agostino Tuccio
1Department of Urology, University of Florence, Careggi Hospital, Florence, Italy. giampaolo.siena@gmail.com
Aims:
To investigate the potential role of tumor enucleation (TE) for the treatment of giant angiomyolipomas (AML).
Methods:
We retrospectively analyzed a prospectively derived database of 707 patients with kidney tumor, who were treated with conservative surgery, between January 1995 and September 2009. Overall, 31 patients had a histopathologic diagnosis of renal AML and of those, 3 patients had a diagnosis of unilateral or bilateral renal mass, with at least one clinically suggestive of giant AML (maximal tumor diameter > or = 9 cm), either central or perihilar. These patients were the subjects of the analysis. Nephron sparing surgery (NSS) was performed as tumor enucleation (TE), carried out by a blunt dissection, using the natural cleavage plane between the tumor and the normal parenchyma.
Results:
Preoperative tumor size ranged between 9.0 and 15.0 centimetres. At surgery, after kidney capsule incision, TE was done in all cases. In critical surgical steps, in case of difficult visualization of the correct enucleation plane, a sharp dissection a few millimetres away from the tumor was adopted. Warm ischemia time (WIT) was always below 20 minutes. Intraoperative blood loss was negligible. Unsignificant postoperative creatinine variation was recorded in all cases. No intra- and post-operative complications occurred. At last follow up visit, no tumor recurrence at the enucleation site was reported.
Conclusions:
TE technique can be considered a viable and effective treatment option for this very rare pathologic condition, since it provides a maximal glomerular preservation and minimizes WIT and intra- and postoperative complications.
Insights
Tumor enucleation (TE) is a safe and effective surgical option for giant angiomyolipomas (AML), preserving kidney function and minimizing complications. This nephron-sparing surgery technique offers excellent outcomes for this rare condition.
Area of Science:
- Urology
- Surgical Oncology
- Nephrology
Background:
- Giant angiomyolipomas (AML) are rare renal tumors, often requiring surgical intervention.
- Conservative surgery, including nephron-sparing approaches, is preferred for renal masses.
- Tumor enucleation (TE) is a specific nephron-sparing surgery (NSS) technique.
Observation:
- This study analyzed 3 patients with giant AML (≥9 cm) treated with TE.
- TE involved blunt dissection along the natural cleavage plane, with sharp dissection used sparingly.
- All procedures maintained warm ischemia time (WIT) under 20 minutes with negligible blood loss.
Findings:
- TE was successfully performed in all giant AML cases.
- No intra- or postoperative complications were observed.
- Postoperative renal function showed insignificant creatinine variation, with no recurrence at follow-up.
Implications:
- TE is a viable and effective treatment for giant AML, offering maximal glomerular preservation.
- The technique minimizes warm ischemia time and surgical complications.
- TE represents a valuable NSS option for managing rare, large renal tumors.
