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Laparoscopic partial nephrectomy for multiple (four) tumors.

Lessandro Curcio¹, Bruno Salama¹, Daniel Luis Pinto¹

¹Hospital Federal Ipanema, RJ, Brasil.

International Braz J Urol : Official Journal of the Brazilian Society of Urology

|October 26, 2016

Summary

Nephron sparing surgery (NSS) effectively treats multiple kidney tumors. This laparoscopic approach successfully removed four papillary cancers from one kidney with clear margins, demonstrating NSS feasibility for complex cases.

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Area of Science:

Urology
Surgical Oncology
Nephrology

Background:

Nephron sparing surgery (NSS) is the standard for small renal tumors.
Multifocal renal tumors occur in 5.4%–25% of patients with tumors <5cm.
Laparoscopic techniques are increasingly utilized for complex renal tumor resections.

Observation:

A 58-year-old male presented with four left kidney nodules detected via ultrasound and MRI.
Imaging suggested papillary renal cell carcinoma due to high cellularity and low vascularization.
The patient underwent a two-stage partial nephrectomy for the multifocal tumors.

Findings:

The surgery involved two stages: warm ischemia for inferior pole tumors and non-ischemic resection for others.
Total operative time was 220 minutes with 800mL blood loss; ischemia time was 35 minutes.
Histopathology confirmed four papillary renal cell carcinomas with negative surgical margins.

Implications:

NSS is a viable option for patients with multiple renal tumors.
Laparoscopic or robotic approaches enhance feasibility and outcomes for NSS in multifocal disease.
Surgical strategy (clamping vs. non-clamping) should be guided by tumor characteristics like the RENAL score.