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Yin J, Zheng M. Ipsilateral synchronous papillary and clear renal cell carcinoma: A case report and review of literature. World J Clin Cases 2022; 10:5428-5434. [PMID: 35812682 PMCID: PMC9210906 DOI: 10.12998/wjcc.v10.i16.5428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/12/2021] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is limited information on ipsilateral synchronous papillary renal cell carcinoma (PRCC) and clear cell renal cell carcinoma (CCRCC). Therefore, these rare tumors are often misdiagnosed preoperatively as a single tumor with intrarenal metastasis or some other diseases. Effective management and long-term overall survival might be affected because the prognosis of the two tumors differs.
CASE SUMMARY We describe a case of ipsilateral synchronous PRCC and CCRCC with two histological variants in a 72-year-old man, whose mass was found incidentally, with no other chief complaints and vital signs were normal. Initial ultrasound revealed a hypoechoic lobular mass with a volume of 7.8 cm × 4.8 cm × 2.8 cm in the middle to lower pole of the left kidney. A subsequent contrast-enhanced computed tomography scan showed a single endophytic mass of 7.5 cm in diameter. The patient underwent laparoscopic left radical nephrectomy. A final diagnosis of ipsilateral synchronous PRCC and CCRCC was confirmed by pathological examination. There was no recurrence or metastasis after 25 mo follow-up.
CONCLUSION We report a case of ipsilateral synchronous PRCC and CCRCC, and review related literature to estimate the prevalence of similar cases. The above descriptions may be expected to help understand the disease, and improve diagnosis in the future.
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Affiliation(s)
- Jing Yin
- Department of Pathology, The Fifth Central Hospital of Tianjin, Binhai New Area, Tianjin 300450, China
| | - Mo Zheng
- Department of Pathology, The Fifth Central Hospital of Tianjin, Binhai New Area, Tianjin 300450, China
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Yerram NK, Dagenais J, Bryk DJ, Nandanan N, Maurice MJ, Mouracade P, Kara O, Kaouk JH. Trifecta Outcomes in Multifocal Tumors: A Comparison Between Robotic and Open Partial Nephrectomy. J Endourol 2018; 32:615-620. [PMID: 29790375 DOI: 10.1089/end.2018.0134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To report a comparative analysis of outcomes in patients who underwent multiple excisions for unilateral synchronous multifocal renal tumors using both open and robotic approaches. METHODS We retrospectively reviewed 110 patients who underwent robotic and open partial nephrectomy and had multiple tumor excisions in an ipsilateral kidney. "Trifecta" was defined as negative surgical margins, no urologic complications, and a glomerular filtration rate (GFR) preservation of ≥90% at last follow-up. Inverse probability of treatment weighting (IPTW) was applied to equilibrate treatment groups, minimize selection bias, and optimize inference on the basis of each patient's clinicodemographic characteristics. RESULTS Sixty-eight robotic and 42 open patient approaches had sufficient data for IPTW. After weighting, there were no statistical differences in baseline characteristics between the two groups. On adjusted analyses, robotic partial nephrectomy achieved equivalent rates of trifecta to open surgery (16.3% vs 16.5%, p = 0.99), which persisted on subgroup analyses of patients with two (20.1% vs 23.7%, p = 0.82) or more than two tumors (6.8% vs 7.4%, p = 0.95). There were no differences between robotic and open cohorts for negative margin rates, absence of complications, or GFR ≥90%. The robotic cohort had a shorter mean length of stay (3.4 vs 4.9 days, p < 0.001). CONCLUSIONS Surgical resection remains the mainstay for patients with unilateral, synchronous, and multifocal renal tumors. Our analysis found that both open and robotic approaches to partial nephrectomy are equally likely to achieve the "trifecta" outcome in an equilibrated high-risk group of patients. The robotic approach for these complex patients may be safe and feasible for a carefully selected group of patients.
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Affiliation(s)
- Nitin K Yerram
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Julien Dagenais
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Darren J Bryk
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Naveen Nandanan
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.,2 Virginia Commonwealth University Health System , Urology, Richmond, Virginia
| | - Matthew J Maurice
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Pascal Mouracade
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Onder Kara
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.,3 Urology Department, Amasya University , Amasya, Turkey
| | - Jihad H Kaouk
- 1 Department of Urology, Glickman Urologic and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
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Tan M, Xu Y, Xu D, Jiang J, Zhao W, Cui D, Ruan Y, Xia S. Laparoscopic Partial Nephrectomy With Sequential Precise Tumor-specific Segmental Renal Artery Clamping for Multiple Ipsilateral Renal Tumors: A New Treatment Approach and Initial Experience. Urology 2017; 108:102-107. [PMID: 28739404 DOI: 10.1016/j.urology.2017.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/07/2017] [Accepted: 07/10/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To present our surgical approach and initial experience of laparoscopic partial nephrectomy (LPN) with sequential precise tumor-specific segmental renal artery clamping in patients with multiple ipsilateral renal tumors. MATERIALS AND METHODS Six patients with multiple ipsilateral renal tumors having imperative indications for nephron-sparing surgery underwent LPN with sequential precise tumor-specific segmental renal artery clamping from May 2012 to September 2015. Patient demographics, perioperative variables, renal functions, and postoperative outcomes were reviewed. RESULTS Overall 15 tumors in 6 patients underwent the sequential precise tumor-specific segmental renal artery clamping LPN without conversion to conventional main renal artery clamping, open surgery, or radical nephrectomy. No severe complication occurred. Mean size of the tumors was 2.5 cm (range 1.8-3.5). Mean tumor-related warm ischemia time was 17 min (range 13-22). The affected kidney functions minimally decreased at recent follow-up and restored 3 months later. No positive tumor margin or extrarenal invasion breakthrough renal capsule was observed after pathologic analysis. Over 12 months' follow-up, no local recurrence and distant metastasis were discovered in these cases postoperatively. CONCLUSION LPN with sequential precise tumor-specific segmental renal artery clamping is a feasible approach for multiple ipsilateral renal tumors. It minimizes intraoperative warm ischemic injury and promotes encouraging postoperative function of the affected kidney.
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Affiliation(s)
- Mingyue Tan
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yongzhi Xu
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dongliang Xu
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Juntao Jiang
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Zhao
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Di Cui
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Ruan
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shujie Xia
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Abstract
PURPOSE OF REVIEW Despite the controversy surrounding the benefits of nephron-sparing surgery, multiple absolute indications for nephron-sparing surgery still exist, including the classic indications of hereditary and bilateral kidney tumors. RECENT FINDINGS Multiple genetic mutations have been identified which lead to hereditary kidney cancer conditions. These are briefly reviewed because the surgical management of hereditary kidney tumors depends on the genetic and histologic subtypes involved. Clear understanding of these hereditary conditions is crucial for proper surgical management of these tumors. SUMMARY Complex partial nephrectomy for multiple renal tumors, or multiplex partial nephrectomy, requires not only exceptional surgical skills but expertise of numerous nonsurgical methodologies, such as hands-on intraoperative ultrasonography and interpretation of multiple imaging modalities. In addition, multidisciplinary management is crucial for optimal outcomes in patient care. This review evaluates the most advanced surgical techniques and perioperative management required to successfully care for these challenging cases.
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Gupta P, Allen BC, Chen MY, Childs DD, Kota G, Zagoria RJ. Renal function outcomes for multifocal renal neoplasms managed by radiofrequency ablation. Cardiovasc Intervent Radiol 2013; 36:1329-35. [PMID: 23361116 DOI: 10.1007/s00270-013-0563-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 12/26/2012] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate renal function changes related to radiofrequency ablation (RFA) for the treatment of multifocal renal neoplasms. METHODS This is an institutional review board-approved, Health Insurance Portability and Accountability Act compliant retrospective study of all patients treated with computed tomography guided RFA for multifocal renal neoplasms at one institution. Fifty-seven subjects, mean age 70 (range 37-88) years, underwent RFA of 169 renal neoplasms (average size 2.0 cm). Subjects had between 2 and 8 (mean 2.96) neoplasms ablated. Estimated glomerular filtration rate (eGFR) was measured before and after RFA. Complications related to RFA were recorded. RESULTS eGFR decreased on average of 4.4 % per tumor treated and 6.7 % per ablation session (average 1.76 tumors treated per session). For subjects with the largest neoplasm measuring >3 cm, eGFR decreased an average of 14.5 % during the course of their treatment. If the largest neoplasm measured 2-3 cm, eGFR decreased an average of 7.7 %, and if the largest neoplasm measured <2 cm, eGFR decreased an average of 3.8 %. Subjects with reduced baseline renal function were more likely to have a greater decline in eGFR after RFA. There was a minor complication rate of 6.3 % (6 of 96 sessions), none of which required treatment, and a major complication rate of 4.2 % (4 of 96 sessions). CONCLUSION RFA for the treatment of multifocal renal neoplasms results in mild decline of renal function.
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Affiliation(s)
- Pushpender Gupta
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA,
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Shuch B, Singer EA, Bratslavsky G. The Surgical Approach to Multifocal Renal Cancers: Hereditary Syndromes, Ipsilateral Multifocality, and Bilateral Tumors. Urol Clin North Am 2012; 39:133-48, v. [DOI: 10.1016/j.ucl.2012.01.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Tsivian A, Tsivian M, Stanevsky Y, Benjamin S, Sidi AA. Laparoscopic partial nephrectomy: beyond the straightforward T1a. BJU Int 2012; 110:738-42. [DOI: 10.1111/j.1464-410x.2012.10955.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Laydner H, Autorino R, Spana G, Altunrende F, Yang B, Khanna R, White MA, Isac W, Hillyer S, Haber GP, Stein RJ, Kaouk JH. Robot-assisted partial nephrectomy for sporadic ipsilateral multifocal renal tumours. BJU Int 2011; 109:274-80. [DOI: 10.1111/j.1464-410x.2011.10319.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Tsivian A, Tsivian M, Benjamin S, Sidi AA. Laparoscopic partial nephrectomy for multiple tumours: feasibility and analysis of peri-operative outcomes. BJU Int 2010; 108:1330-4. [PMID: 21199286 DOI: 10.1111/j.1464-410x.2010.09995.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE • To describe our experience with laparoscopic partial nephrectomy (LPN) for multiple kidney tumours and compare the outcomes with LPN performed for single masses. PATIENTS AND METHODS • Retrospective analysis of medical records of patients undergoing LPN at our institution between 2005 and 2009 was performed. • The cohort was divided in two groups based on tumour focality: group 1, LPN for a single tumour (n= 99) and group 2, LPN for multiple ipsilateral tumours (n= 12). • The groups were compared with regards to demographic and peri-operative variables. RESULTS • Demographic variables were not different between the groups. Median dominant tumour size was 3.1 cm (interquartile range [IQR] 2.4-4.0) and 4.0 cm (2.3-5.9) in groups 1 and 2, respectively. • Median secondary tumour size in group 2 was 1.0 cm (1.0-1.8). • Operative times were longer in group 2 compared with group 1 (220 vs 160 min, P= 0.009). • Warm ischaemia times (WIT) (23 vs 22 min) and estimated blood loss (EBL) (100 vs 85 mL) were similar. CONCLUSIONS • LPN is a viable option for the treatment of multiple ipsilateral renal tumours. • Peri-operative outcomes are similar to standard LPN with the exception of longer operative time. • In experienced hands, the advantages of minimally invasive surgery may be extended to select patients with ipsilateral multifocal renal tumours.
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Affiliation(s)
- Alexander Tsivian
- Department of Urologic Surgery, the E. Wolfson Medical Center, Holon, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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