The surgical management of renal cell carcinoma

The natural history of metastatic renal cell carcinoma: a computer analysis

Survival factors of 86 patients with metastatic renal cell carcinoma were studied by computer analysis. Cumulative survival was 53 per cent at 6 months, 43 per cent at 1 year, 26 per cent at 2 years and 13 per cent at 5 years. Survival was influenced favorably by confinement of metastases to the lungs, by the absence of local recurrence or persistence of tumor and by a longer interval free of disease after removal of the primary tumor. Medical therapy improved survival during the first year after diagnosis of metastases but no objective regression of tumor was observed. Excision of metastatic foci significantly improved survival for up to 5 years (p less than 0.05 and p less than 0.02) after which most patients died of recurrence. Palliative or adjunctive nephrectomy in patients with metastases was associated with a 6 per cent mortality rate but it increases survival over other patients with metastases at the time of diagnosis of renal carcinoma who did not undergo nephrectomy. This difference was owing to patient selection and survival of those who had adjunctive nephrectomy was no greater than that of the study population as a whole. However, based on the factors that were associated with improved survival palliative nephrectomy may be beneficial when a limited number of metastases treatable by excision or radiation therapy are present, when effective systemic therapy exists or when the primary tumor produces severe symptoms.

Radical retroperitoneal surgery: a 25-year experience

A review of 210 radical retroperitoneal excisions performed through an abdominal or flank thoracoabdominal incision showed these procedures to be relatively safe. The flank approach had less morbidity and provided better exposure of the renal hilus and suprarenal areas. Pulmonary complications in the flank thoracoabdominal incision were reduced by closing the thorax with an indwelling pleural drainage tube. The flank thoracoabdominal approach is suitable for all radical retroperitoneal excision when extensive bilateral renal exposure is not needed.

Nephrectomy: indications and complications in 347 patients

The indications, complications and mortality rate in a recent 12-year experience with 347 nephrectomies were reviewed. Renal tumor is the most frequent condition requiring nephrectomy, probably because of the improved, non-ablative methods to treat inflammatory, obstructive, calculous and hypertensive renal disease. The over-all mortality rate was 1.4 per cent but was almost nil in the absence of malignancy.

Experience gained from the management of 9 cases of bilateral renal cell carcinoma

Radical nephrectomy is the traditional therapy for renal cell carcinoma. However, modification of this technique is necessary when bilateral renal cell carcinoma occurs (3.8 per cent of all renal cell carcinomas at our institution). Special attention should be paid to the contralateral kidney when the diagnosis of renal cell carcinoma is made, since an inapparent contralateral tumor may also be present (2 of 9 cases). An aggressive approach, consisting of in vivo heminephrectomy and a contralateral procedure, has avoided operative mortality or bench surgery, maintained life-sustaining renal function and produced a reasonable long-term survival rate.

Successful extraction of intracardiac tumor thrombus of renal carcinoma

Successful management of a patient with an intracardiac tumor thrombus of renal carcinoma is described. Important considerations in the management include precise localization of the upper limits of the tumor thrombus preoperatively, early ligation of the renal artery, control of the circulation through the inferior vena cava by temporary occlusion of the vena cava below the renal veins, the left renal vein and the hepatic circulation, and a team approach, using the expertise of the urologist and the cardiac surgeon, as well as cardiopulmonary bypass.

Excision of multiple intracranial metastatic hypernephroma. Report of a case with a 7-year survival

The authors report a case of cerebral and cerebellar metastatic renal carcinoma with 7-year survival without present evidence of recurrence following excision of both intracranial lesions and the primary lesion (by radical nephrectomy).

Adrenal insufficiency after unilateral radical nephrectomy

A case of adrenal insufficiency occurring after unilateral radical nephrectomy is presented. Recommendations for identification and treatment of this condition are discussed.

The staging of renal parenchymal tumours

The relation between the anatomical features in the development of renal parenchymal tumours and the prognosis are analysed. It is suggested that the clinical and anatomical classification must be revised.