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Choudhary D, Naik M, Vageesh BG, Agarwal A. A case report of liver infiltration from a large renal cell carcinoma: Diagnostic and management enigma. Int J Surg Case Rep 2024; 114:109045. [PMID: 38039569 PMCID: PMC10730738 DOI: 10.1016/j.ijscr.2023.109045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Renal cell carcinoma is the most lethal malignancy of urinary tract. Invasion of right lobe of liver by Renal cell carcinoma is rare and possess a treatment challenge. Simultaneous nephrectomy with right hepatectomy has been proposed as a part of multi-modality treatment approach. But its safety and feasibility is not well established. CASE PRESENTATION We herein discuss a case of 30-year old female patient who underwent simultaneous nephrectomy with right hepatectomy along with single peritoneal metastasectomy for a huge Renal cell carcinoma of right kidney and infiltrating the right lobe of liver. Intra-operatively a single peritoneal nodule was present which came positive for malignancy on frozen section. Considering young age, good performance status and oligometastatic disease definitive procedure in the form of combined right nephrectomy and right hepatectomy was performed. She was discharged from the hospital on 6th post-operative day with an uneventful post-operative course. CLINICAL DISCUSSION The patients with locally advanced Renal cell carcinoma with involvement of adjacent organs require en block surgical resection in combination with targeted therapy and immunotherapy. The surgical management of patients with direct liver infiltration requires a right nephrectomy with some form of liver resection based on the extent of liver involvement to achieve a margin negative resection. In our case a plan of formal right hepatectomy was made as the tumor was infiltrating into segment VI, VII, and VIII. CONCLUSION The combined nephrectomy and right hepatectomy is safe and feasible for this type of huge RCC invading right hepatic lobe.
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Affiliation(s)
- Devendra Choudhary
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Medical Education and Research, New Delhi, India.
| | - Maktum Naik
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Medical Education and Research, New Delhi, India
| | - B G Vageesh
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Medical Education and Research, New Delhi, India
| | - Anil Agarwal
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Medical Education and Research, New Delhi, India
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Lim K, Riveros C, Ranganathan S, Xu J, Patel A, Slawin J, Ordonez A, Aghazadeh M, Morgan M, Miles BJ, Esnaola N, Klaassen Z, Allenson K, Brooks M, Wallis CJD, Satkunasivam R. Morbidity and mortality of multivisceral resection with radical nephrectomy for locally advanced renal cell carcinoma: An analysis of the National Surgical Quality Improvement Program (NSQIP) database. Urol Oncol 2023; 41:209.e1-209.e9. [PMID: 36801191 DOI: 10.1016/j.urolonc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/09/2022] [Accepted: 01/09/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Locally advanced renal cell carcinoma (RCC) can rarely invade into adjacent abdominal viscera without clinical evidence of distant metastases. The role of multivisceral resection (MVR) of involved adjacent organs at the time of radical nephrectomy (RN) remains poorly described and quantified. Using a national database, we aimed to evaluate the association between RN+MVR and 30-day postoperative complications. METHODS AND MATERIALS We conducted a retrospective cohort study of adult patients undergoing RN for RCC with and without MVR between 2005 and 2020 using the ACS-NSQIP database. The primary outcome was a composite of any of the following 30-day major postoperative complications: mortality, reoperation, cardiac event, and neurologic event. Secondary outcomes included individual components of the composite primary outcome, as well as infectious and venous thromboembolic complications, unplanned intubation and ventilation, transfusion, readmission, and prolonged length of stay (LOS). Groups were balanced using propensity score matching. Likelihood of complications was assessed by conditional logistic regression adjusted for unbalanced total operation time. Postoperative complications were compared by Fisher's exact test among subtypes of resection. RESULTS A total of 12,417 patients were identified: 12,193 (98.2%) undergoing RN alone and 224 (1.8%) undergoing RN+MVR. Patients undergoing RN+MVR were more likely to experience major complications (odds ratio [OR] 2.46; 95% confidence interval [CI] 1.28-4.74). However, there was no significant association between RN+MVR and postoperative mortality (OR 2.49; 95% CI 0.89-7.01). RN+MVR was associated with higher rates of reoperation (OR 7.85; 95% CI 2.38-25.8), sepsis (OR 5.45; 95% CI 1.83-16.2), surgical site infection (OR 4.41; 95% CI 2.14-9.07), blood transfusion (OR 2.24; 95% CI 1.55-3.22), readmission (OR 1.78; 95% CI 1.11-2.84), infectious complications (OR 2.62; 95% CI 1.62-4.24), and longer hospital stay (5 days [IQR 3-8] vs. 4 days [IQR 3-7]; OR 2.31 [95% CI 2.13-3.03]). There was no heterogeneity in the association between subtype of MVR and major complication rate. CONCLUSION Undergoing RN+MVR is associated with an increased risk of 30-day postoperative morbidity, including infectious complications, reoperation, blood transfusion, prolonged LOS, and readmission.
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Affiliation(s)
- Kelvin Lim
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | | | - Jiaqiong Xu
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, TX
| | - Ashmi Patel
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Jeremy Slawin
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Adriana Ordonez
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, TX
| | - Monty Aghazadeh
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Monica Morgan
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Brian J Miles
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Nestor Esnaola
- Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta, GA
| | - Kelvin Allenson
- Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - Michael Brooks
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Christopher J D Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Urology, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Mount Sinai Hospital, Toronto, Ontario, Canada
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Glybochko PV, Alyaev YG, Khokhlachev SB, Fiev DN, Shpot EV, Petrovsky NV, Zhang D, Proskura AV, Yurova M, Matz EL, Wang X, Atala A, Zhang Y, Butnaru DV. 3D reconstruction of CT scans aid in preoperative planning for sarcomatoid renal cancer: A case report and mini-review. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:389-395. [PMID: 30689600 DOI: 10.3233/xst-180387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Contrast-enhanced multi-slice computed tomography (MSCT) is commonly used in the diagnosis of complex malignant tumours. This technology provides comprehensive and accurate information about tumour size and shape in relation to solid tumours and the affected adjacent organs and tissues. This case report demonstrates the benefit of using MSCT 3D imaging for preoperative planning in a patient with late-stage (T4) sarcomatoid renal cell carcinoma, a rare renal malignant tumour. The surgical margin on the liver was negative, and no metastases to veins, lungs or other organs were detected by abdominal and chest contrast-enhanced CT. Although sarcomatoid histology is considered to be a poor prognostic factor, the patient is alive and well 17 months after surgery. The MSCT imaging modality enables 3D rendering of an area of interest, which assists surgical decision-making in cases of advanced renal tumours. In this case, as a result of MSCT 3D reconstruction, the patient received justified surgical treatment without compromising oncological principles.
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Affiliation(s)
- Petr V Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Yuriy G Alyaev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Sergey B Khokhlachev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Dmitriy N Fiev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Evgeniy V Shpot
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Nikolay V Petrovsky
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Deying Zhang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Alexandra V Proskura
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Maria Yurova
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Ethan Lester Matz
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Xisheng Wang
- Department of Urology, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Anthony Atala
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Yuanyuan Zhang
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Denis V Butnaru
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
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A safe combined nephrectomy and right lobectomy using the liver hanging maneuver for huge renal cell carcinoma directly invading the right lobe of the liver: report of a case. Surg Today 2013; 44:1778-82. [PMID: 24048764 PMCID: PMC4138431 DOI: 10.1007/s00595-013-0693-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 04/19/2013] [Indexed: 11/19/2022]
Abstract
We herein discuss a patient who underwent simultaneous combined right nephrectomy and right lobectomy of the liver. A 64-year-old male was diagnosed with a huge right renal cell carcinoma (RCC), 13 cm in diameter, which was invading directly into the right hepatic lobe. This type of RCC has been rarely reported, and an anterior approach using the liver hanging maneuver was extremely useful during hepatic parenchymal dissection. The liver parenchymal dissection was performed prior to mobilization of the liver, because the mobilization of the right lobe of the liver was impossible. During the hepatic parenchymal resection, the liver was suspended with the tape and transected, and thereafter, retroperitoneal dissection, nephrectomy and right lobectomy of the liver were completed. The patient was discharged from the hospital on the 12th postoperative day with an uneventful clinical course. The anterior approach using the liver hanging maneuver during hepatic parenchymal resection can be safe and feasible for huge RCC invading the right hepatic lobe.
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Pitchaimuthu M, Pai M, Habib NA. Partial nephrectomy and enbloc liver resection using a bipolar radiofrequency device for renal cell carcinoma invading the liver. BMJ Case Rep 2010; 2010:2010/oct27_1/bcr1020092340. [PMID: 22791734 DOI: 10.1136/bcr.10.2009.2340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 66-year-old man presented with right- sided abdominal pain. Ultrasound, CT and MRI scans showed a right renal mass arising from the upper pole with direct involvement of the right lobe of the liver. Biopsy confirmed renal cell carcinoma. After Multi Disciplinary Team (MDT) discussion, right partial nephrectomy with enbloc resection of segments VI and VII of the liver was performed with the help of intraoperative ultrasound scan and the Habib 4X bipolar radiofrequency device. Apart from symptomatic collection, which was drained radiologically, the patient made a good recovery. The patient developed recurrence at the resection margin but is in remission following chemotherapy at 12 months.
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Affiliation(s)
- M Pitchaimuthu
- HPB Surgery, Imperial College Healthcare NHS Trust, London, UK.
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Liver resection for metastatic disease prolongs survival in renal cell carcinoma: 12-year results from a retrospective comparative analysis. World J Urol 2010; 28:543-7. [PMID: 20440505 DOI: 10.1007/s00345-010-0560-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 04/14/2010] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED The value of surgical resection of renal cell carcinoma (RCC) liver metastases still remains unclear. OBJECTIVE Of our study was to evaluate the efficacy of liver resection by comparing patients who could have undergone metastasectomy due to limited disease, but refused surgery. MATERIALS AND METHODS Eighty-eight patients were identified with liver metastases and indication of surgery between 1995 and 2006. In 68 patients, liver resection was performed, 20 patients denied surgery and served as comparison group. Patients were followed for survival. RESULTS Median age was 58. Median amount of liver metastases was 2 (range 1-30). Median follow-up was 26 months (range 1-187). In both groups, 79% received systemic therapy. The 5-year overall survival rate (OSR-5) after metastasectomy was 62.2% +/- 11.4% (SEM) with a median survival (MS) of 142 (95% confidence interval (CI) 115-169) months. OSR-5 in the control group was 29.3% +/- 22.0% (SEM) with a MS of 27 (95% CI 16-38) months (P = 0.003). MS was 155 (95% CI 133-175) months with metachronous metastases compared to 29 (95% CI 25-33) months in the comparison group (P = 0.001). Low-grade primary RCC had a MS of 155 (95% CI 123-187) months compared to 29 (95% CI 8-50) months without resection (P = 0.0036). High-grade RCC as well as patients with synchronous metastases did not benefit from surgery. CONCLUSIONS Liver metastasectomy is an independent valuable tool in the treatment of metastatic RCC and significantly prolongs patient's survival, even if further systemic treatment is necessary. With the evidence given, patients may benefit from liver metastasis resection if technically feasible.
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Yezhelyev M, Master V, Egnatashvili V, Kooby DA. Combined nephrectomy and major hepatectomy: indications, outcomes, and recommendations. J Am Coll Surg 2009; 208:410-8. [PMID: 19318003 DOI: 10.1016/j.jamcollsurg.2008.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Revised: 12/03/2008] [Accepted: 12/04/2008] [Indexed: 01/12/2023]
Abstract
BACKGROUND Simultaneous nephrectomy with major hepatectomy (NMH) is uncommon. We reviewed our experience with NMH. STUDY DESIGN Records of patients who underwent NMH at Emory Hospital between January 1995 and May 2008 were examined. Patients undergoing resection of three or more liver segments at the same setting as a total nephrectomy were included. Indications and outcomes were assessed. RESULTS Twenty patients underwent NMH. Mean (+/- SD) age was 59.9+/-12.8 years, 6 (30%) were women, and 15 (75%) presented with comorbidities. Most kidney neoplasms were renal cell carcinomas of the right kidney (n=16, 80%) with a mean diameter of 10.0+/-6.1 cm. Eight patients (40%) also underwent thrombectomy for inferior vena cava tumor thrombus. The most common indications for hepatectomy were direct liver invasion in eight patients (40%) and distant hepatic metastases in nine (45%); liver tumors were 4.2+/-3.3 cm (mean +/- SD) in diameter. Mean (+/- SD) operative time was 8.3+/-2.6 hours. Liver resections included 15 (75%) right hepatectomies and 5 (25%) left hepatectomies. In all cases, tumor negative hepatic margins were achieved. Median operative blood loss was 1,700 mL (range 200 to 8,000 mL). Ten patients (50%) suffered complications in the postoperative period; three of these suffered major complications, resulting in one perioperative death (5%). Mean hospital stay was 12+/-8.8 days. Overall survival was 25 months (range 0 to 34 months). CONCLUSIONS In this large series of nephrectomy with simultaneous major hepatectomy, morbidity and mortality were acceptable. In specialized centers NMH may be considered in properly selected patients for combined resection for synchronous neoplasms of the kidney and liver.
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Affiliation(s)
- Maksym Yezhelyev
- Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
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Solitary Liver Metastasis of Chromophobe Renal Cell Carcinoma 20 Years After Nephrectomy Treated by Hepatic Resection. Urology 2008; 72:230.e5-6. [DOI: 10.1016/j.urology.2007.11.134] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 11/14/2007] [Accepted: 11/27/2007] [Indexed: 11/23/2022]
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Quicios Dorado C, Mayayo Dehesa T, Nuño Vázquez-Gaza J, García Teruel D, López Buenadicha A, Díez Nicolás V. Tumor renal con invasión hepática: aportación de un nuevo caso y revisión de la literatura. Actas Urol Esp 2007; 31:541-7. [PMID: 17711174 DOI: 10.1016/s0210-4806(07)73679-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Locally advanced renal cell carcinoma (RCC) with involvement to adjacent organs is uncommon and the prognosis is poor. Radical surgery remains the only effective treatment. We report the case of a woman with RCC and direct liver extension who was surgically treated. A literature review is made.
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Wong JA, Whelan T, Morse M. Radical nephrectomy with en bloc resection of liver, diaphragm, and lung for locally invasive sarcomatoid renal cell carcinoma. Urology 2006; 68:890.e1-4. [PMID: 17070379 DOI: 10.1016/j.urology.2006.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Revised: 03/06/2006] [Accepted: 04/03/2006] [Indexed: 11/21/2022]
Abstract
Despite the widespread use of abdominal imaging, some patients with renal cell carcinoma still present with advanced disease. We report 1 case of locally invasive sarcomatoid renal cell carcinoma requiring resection of the kidney, adrenal glands, liver, diaphragm, and lung, with diaphragmatic reconstruction with a polytetrafluoroethylene patch. The patient was alive and well 5 years postoperatively. However, we acknowledge that the success experienced with this case does not represent the typical outcome for a patient with such advanced disease.
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Affiliation(s)
- Jaime A Wong
- Department of Urology, Dalhousie University, QEII Health Sciences Centre, Halifax, Canada
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