Neoplasia of the solitary kidney

Kidney preserving surgery in renal cell tumors: indications, techniques and results in 152 patients

Between 1975 and 1991, 142 patients with renal cell carcinoma and 10 with oncocytoma underwent a total of 164 kidney preserving operations. The indication for surgery was imperative (group 1, 47 patients) among those with a solitary kidney (9), renal insufficiency (17) or bilateral tumors (21). Of the patients with small or peripheral tumors and a healthy contralateral kidney 105 were selected for elective surgery (group 2). Most procedures were done either without ischemia (24%) or with warm ischemia (69%). In some patients from the imperative indication group hypothermia was achieved by in situ perfusion (5%) or ex vivo work bench surgery and autotransplantation (2%). Complication rates were 15% for group 1 and 9.5% for group 2. In group 1, 3 patients died of cancer, 5 lived with metastases and 2 had local tumor recurrence. No patient in group 2 had recurrences or metastases. The tumor-specific survival rate of patients with kidney preservation for renal cell carcinoma was comparable to that of a control group undergoing radical nephrectomy. Due to the high reliability and efficacy, kidney preserving surgery for renal cell carcinoma should be done more often, even in patients with a normally functioning contralateral kidney.

Gallbladder and pancreatic metastases from bilateral renal carcinoma presenting with hematobilia and anemia

A case of bilateral metachronous renal cell carcinoma with gallbladder and pancreatic metastases, presenting with hematobilia and anemia is presented. The presentation of metastatic renal cell carcinoma with hematobilia and anemia is previously unreported. This case illustrates (1) the occasionally very long interval between metachronous renal carcinoma; (2) this tumor's propensity to unusual metastases and unpredictable presentation; and (3) the significant palliation which may be achieved by appropriate surgical resection of these metastases.

In situ management of renal tumors: renal cell carcinoma and transitional cell carcinoma

In the last 8 years 15 patients with malignant neoplasms in functionally solitary kidneys underwent in situ excision of the tumor with preservation of renal parenchyma. Of 10 patients with renal cell carcinoma 8 underwent partial nephrectomy, 1 had a central wedge resection and 1 had enucleation of 3 tumors. After followup of 6 months to 4.7 years 6 patients are free of disease. One patient died of metastatic cancer and 1 of cardiovascular disease. Of 5 patients with transitional cell carcinoma of the kidney (including 2 with parenchymal invasion) 2 underwent partial nephrectomy and 3 underwent extensive resection of renal pelvic lesions. After followup of 6 months to 7 years 2 patients are alive, 2 died of metastatic disease and 1 died of metastatic bladder carcinoma. Only 1 of the 5 patients had locally recurrent tumor. These data demonstrate the efficacy of in situ management of renal tumors in selected patients with solitary kidneys or compromised renal function.

Treatment of solitary and bilateral renal carcinomas

Recent experience with 7 patients, as well as a review of the literature, indicates that partial nephrectomy provides satisfactory treatment of solitary and bilateral renal adenocarcinomas. Patient survival seems to be dependent on the adequacy of tumor resection and not on the fate of the contralateral kidney. Total nephrectomy, dialysis and subsequent transplantation are viable alternatives when it is technically not possible to preserve adequate renal parenchyma.

Conservative surgery in solitary and bilateral renal carcinoma: indications and technical considerations

Seven patients presented with solitary or bilateral renal carcinoma. All 4 patients treated by partial nephrectomy are well and 3 are free of disease (followup of 24 to 32 months). A survey of similar series reveals a survival of 78 per cent in patients with solitary renal tumors undergoing partial nephrectomy (mean followup of 52 months). Since the projected survival in patients undergoing chronic hemodialysis for the same interval is only 65 per cent partial nephrectomy, when technically feasible, would appear to be the treatment of choice in solitary renal carcinoma. In cases involving bilateral lesions the survival rate after partial nephrectomy seems to be similar to that of cases on hemodialysis.

Asymptomatic bilateral hypernephroma: an autopsy case report wtih discussion of possible etiologic factors

The first case of asymptomatic bilateral synchronous hypernephroma is described in a 52-year-old man who had a long history of alcoholic cirrhosis and died of uncontrollable gastrointestinal bleeding. The literature is reviewed briefly and relevant etiologic factors are discussed.

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.

Simultaneous surgical management of bilateral hypernephroma: an alternative therapy

Herein are reported 2 cases of bilateral hypernephroma treated by simultaneous bilateral partial hephrectomy. One patient died of a myocardial infarction 3 years postoperatively and the other is well 30 months postoperatively. Bilateral partial nephrectomy is proposed as an alternative to bilateral nephrectomy and homotransplantation.

Surgical management of renal lesions using in situ hypothermia and ischemia

Many renal lesions that were once treated by nephrectomy now lend themselves to surgical correction. The value of in situ hypothermia and ischemia produced by occlusion of the renal artery is detailed. This technique has proved to be a simple, safe and effective surgical approach to the management of most difficult renal lesions.

Conservative renal surgery for adenocarcinoma. The place of bench surgery

A brief review of reported cases of tumours in solitary kidneys and of bilateral simultaneously occurring tumours is reported. 1 case of bilateral simultaneously occurring tumour ana 3 cases of tumour occurring in solitary kidneys are reported. The treatment of these cases by simple partial nephrectomy under regional hypothermia is described. The palce of ex vivo "Bench Surgery" for this condition is discussed.