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1.
Georgian Med News ; (314): 13-20, 2021 May.
Artigo em Russo | MEDLINE | ID: mdl-34248021

RESUMO

The aim of the study was to conduct an anatomical and clinical study of IVC and its tributaries, and to determine the pathways of collateral venous blood flow to improve the results of surgical treatment of patients with kidney cancer complicated by venous tumor thrombosis. The anatomical examination of the IVC and its tributaries included the results of autopsy of 27 corpses. The clinical part of the study is based on the results of examination and surgical treatment of 147 patients with renal cell carcinoma complicated by venous tumor thrombosis. Tumor of the right kidney was diagnosed in 96 (65.3%) patients, left - in 51 (34.7%) patients. Venous tumor thrombus was localized exclusively in the renal vein (level 0) in 55 (37.4%) cases, while in different IVC segments (levels I-IV) - in 92 (62.6%) cases. At the same time, level I took place in 32 (21.8%), level II - in 30 (20.4%), III - in 22 (15.0%) and IV level - in 8 (5.4%) patients. The spread of a venous tumor thrombus into the main hepatic veins was diagnosed in 1 (0.7%), in the left gonadal vein - in 4 (7.8%), in the left adrenal vein - in 2 (3.9%), into the contralateral renal vein - in 2 (1.4%) cases. Tumor thrombosis of the infrarenal IVC, combined with hemorrhagic thrombosis occurred in 28 (19.0%) patients. Avascular IVC parts were found in the retrohepatic segment under the main hepatic veins with a median length of 13.1 mm and in the infrarenal segment under the right renal vein with a median length of 17.8 mm. 6 basic anatomical structures involved in the formation of the caval venous collector were identified. Despite the broad anatomical possibilities for compensating venous blood flow during IVC occlusion of tumor and hemorrhagic genesis, only surgical treatment can provide a good functional result for venous return through the IVC to the heart. Thrombotic occlusion of the renal and inferior vena cava contributes to the retrograde spread of venous tumor thrombi with the involvement of the vessels in the process, providing a collateral pathway for the outflow of venous blood. To successfully perform thrombectomy from IVC, it is necessary to actively use avascular parts in its retrohepatic and infrarenal segments, taking into account the existing variability in the localization of the posterior and anterior IVC inflows.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Trombose Venosa , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/cirurgia , Nefrectomia , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/complicações , Trombose Venosa/diagnóstico , Trombose Venosa/cirurgia
2.
Hinyokika Kiyo ; 67(6): 233-238, 2021 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-34265898

RESUMO

Renal mucinous tubular and spindle cell carcinoma (MTSCC) is a rare kidney cancer subtype with limited cases reported in the literature. Renal MTSCC has many similarities with papillary renal cell carcinoma (pRCC), and it is therefore often difficult to make a differential diagnosis between them. Herein, we report a case of renal MTSCC. The patient was a 76-year-old woman. Computed tomography revealed a left renal tumor. Magnetic resonance imaging (MRI) demonstrated an iso-intensity or high signal intensity mass on T2-weighted images, high signal intensity on diffusion-weighted images, and weak and gradual enhancement. We diagnosed the patient with left renal cell carcinoma (cT1bN0M0) and performed laparoscopic left nephrectomy in May 2019. The histopathological diagnosis was renal MTSCC. Six months after surgery, the patient remains free of recurrence and of metastasis. MRI is effective for the preoperative differentiation of renal MTSCC from pRCC since renal MTSCC presents an iso-intensity or high signal intensity on MRI T2-weighted images reflecting the mucin component in the intervening stroma within the tumor.


Assuntos
Adenocarcinoma Mucinoso , Carcinoma de Células Renais , Neoplasias Renais , Adenocarcinoma Mucinoso/diagnóstico por imagem , Adenocarcinoma Mucinoso/cirurgia , Idoso , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Recidiva Local de Neoplasia , Nefrectomia
3.
Hinyokika Kiyo ; 67(4): 153-156, 2021 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-34107611

RESUMO

We report the case of a 61-year-old man who was incidentally diagnosed with a left pelvic ectopic kidney with renal tumor. Computed tomography showed a hypervascular tumor at the posterior surface of the ectopic kidney with five arterial and two venous supply vessels. On preoperative examination, this patient had respiratory dysfunction. For these reasons, an open radical nephrectomy was performed. Histological examination revealed a clear cell renal cell carcinoma, pT1aN0M0, G1, and a Fuhrman nuclear grading system grade of G2. No evidence of disease was observed 15 months after surgery.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Humanos , Rim , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Tomografia Computadorizada por Raios X
4.
J Med Case Rep ; 15(1): 314, 2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059139

RESUMO

BACKGROUND: Metastatic spread to the pancreas is a rare event. Renal cell carcinoma represents one possible site of origin of pancreatic metastases. Renal cell carcinoma often metastasizes late and exclusively to the pancreas, suggesting a special role of renal cell carcinoma among primaries metastasizing to the pancreas. Even rarer, renal cell carcinoma may occur simultaneously with pancreatic ductal adenocarcinoma. CASE PRESENTATION: We present the case of a 78-year-old male Caucasian patient with a history of clear-cell renal cell carcinoma treated with oncological left nephrectomy 20 years before. The patient was diagnosed with pancreatic ductal adenocarcinoma by fine-needle aspiration cytology. At our institution, he received neoadjuvant therapy with folic acid, fluorouracil, irinotecan, oxaliplatin for borderline-resectable pancreatic ductal adenocarcinoma, and subsequently underwent total pancreatectomy. Upon resection, pancreatic ductal adenocarcinoma as well as two metachronous metastases of clear-cell renal cell carcinoma occurring simultaneously and cospatially with pancreatic ductal adenocarcinoma were diagnosed in the pancreatic body. CONCLUSIONS: Renal cell carcinoma metastases of the pancreas are rare and often occur decades after the initial diagnosis of renal cell carcinoma. The combination of renal cell carcinoma metastases and pancreatic ductal adenocarcinoma is even rarer. However, the possibility should be considered by clinicians, radiologists, and pathologists. The special role of renal cell carcinoma as a site of origin of pancreatic metastasis should be further elucidated.


Assuntos
Adenocarcinoma , Carcinoma de Células Renais , Neoplasias Renais , Neoplasias Pancreáticas , Idoso , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/cirurgia , Masculino , Pancreatectomia , Neoplasias Pancreáticas/cirurgia
5.
Hinyokika Kiyo ; 67(5): 197-203, 2021 May.
Artigo em Japonês | MEDLINE | ID: mdl-34126663

RESUMO

A man in his 60s was diagnosed with clear cell carcinoma of the right kidney with multiple lung metastases, tumor thrombus of the inferior vena cava (IVC), and invasion of the duodenum and pancreas. Ipilimumab plus nivolumab was administered as first-line therapy. After 3 treatment courses, computed tomography (CT) demonstrated a slight decrease in the size of the primary tumor and lung metastases. However, the patient became hemodynamically unstable due to persistent duodenal bleeding during treatment despite frequent blood transfusions. Axitinib was then initiated as second-line therapy. The duodenal bleeding ceased 10 days after starting axitinib and his anemia remissed. Subsequent CT showed further decrease in the size of the primary tumor and lung metastases. The patient underwent right nephrectomy after improvement of nutrition. IVC thrombectomy, and pancreaticoduodenectomy. The lung metastases disappeared on postoperative imaging and no additional treatment was provided. Twelve months after surgery, he was in good health and showed no signs of recurrence.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Axitinibe , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/cirurgia , Duodeno , Humanos , Ipilimumab/uso terapêutico , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/cirurgia , Masculino , Recidiva Local de Neoplasia , Nefrectomia , Nivolumabe/uso terapêutico , Pâncreas , Trombectomia , Veia Cava Inferior
6.
Medicine (Baltimore) ; 100(19): e25858, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106631

RESUMO

RATIONALE: Acquired cystic disease-associated renal cell carcinoma (ACKD-RCC) is a unique subtype of renal cell carcinoma (RCC) and is found exclusively in patients with end-stage renal disease. We report a case of intracapsular nephrectomy (ICAN) of renal allograft with ACKD-RCC. To our knowledge, this is the first case in Asia of ICAN of renal allograft to treat ACKD-RCC. PATIENT CONCERNS: A 51-year-old male patient with a history of allogeneic kidney transplantation (23 years previously) presented with renal cystic degeneration of the transplanted kidney over the past 2 years. DIAGNOSES: ICAN was used to remove the cystic kidney. INTERVENTIONS: The pathology report indicated clear cell renal cell carcinoma. OUTCOMES: Two years after surgery, computed tomography showed no tumor recurrence, and the patient's creatinine level was 3.5 mg/dl under hemodialysis. LESSONS: Removal of transplanted kidney with ACKD-RCC using ICAN is feasible to provide a mid-term tumor-free survival for the patient. Therefore, we consider nephrectomy as an early treatment for the nonfunctional cystic allograft kidney, in order to reduce the dosage of anti-rejection drugs, avoid the occurrence of transplanted kidney tumor, and provide the possibility for the patient an opportunity to receive a second kidney transplantation.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Humanos , Doenças Renais Císticas/patologia , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Transplante Homólogo
7.
World J Surg Oncol ; 19(1): 190, 2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34183025

RESUMO

BACKGROUND: The purpose of this study was to evaluate the effects of cytoreductive nephrectomy (CN) and metastasectomies on the survival of patients with synchronous metastatic renal cell cancer (mRCC) using real-life, population-based national dataset. METHODS: Nationwide data, including all cases of synchronous mRCC in Finland diagnosed on a 6-year timeframe, based on the Finnish Cancer Registry and complemented with patient records from the treating hospitals, were analyzed. Patients with Eastern Cooperative Oncology Group (ECOG) performance status 3-4 were excluded. Univariate and adjusted multivariable survival analysis were performed, including subgroup analysis for patients with different medical therapies. Nephrectomy complications were also analyzed. RESULTS: A total of 732 patients were included in the analysis. CN was performed for 389 (53.1%) patients, whereas 68 (9.3%) patients underwent nephrectomy and metastasectomies of all lesions (surgery with curative intent). Median overall survival (OS) for patients who did not undergo nephrectomy was 5.9 (95% confidence interval [CI] = 4.6-7.2) months. Patients who had a CN had a median OS of 16.6 (95% CI = 14.2-19.1, p < 0.001) months, whereas patients who had surgery with curative intent had a median OS of 51.3 (95% CI = 36.0-66.6, p < 0.001) months. The survival benefit of CN and metastasectomies remained significant in all medical therapy subgroups and in both of the applied multivariable statistical models. CONCLUSIONS: Surgical treatment of metastatic renal cell cancer is associated with a significant survival benefit in patients with good and moderate performance status, regardless of the chosen medical therapy.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Carcinoma de Células Renais/cirurgia , Procedimentos Cirúrgicos de Citorredução , Finlândia/epidemiologia , Humanos , Neoplasias Renais/cirurgia , Nefrectomia , Prognóstico , Estudos Retrospectivos
8.
World J Surg Oncol ; 19(1): 156, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34034739

RESUMO

BACKGROUND: Renal cell carcinoma (RCC) is a common malignant tumour of the genitourinary system. We aimed to analyse the potential value of metastasis-related biomarkers, circulating tumour cells (CTCs) and the proliferative marker Ki-67 in the diagnosis of RCC. METHODS: Data from 24 laparoscopic radical nephrectomies (RNs) and 17 laparoscopic partial nephrectomies (PNs) were collected in 2018. The numbers and positive rates of CTCs and circulating tumour microemboli (CTM) in the peripheral blood were obtained at three different time points: just before surgery, immediately after surgery and 1 week after surgery. Ki-67 protein expression was evaluated in the RCC tissue by immunohistochemistry. RESULTS: Except for the statistically significant association between the preoperative CTC counts and tumour size, no association between the number and positive rate of perioperative CTCs and clinicopathological features was found. The CTC counts gradually decreased during the perioperative period, and at 1 week after surgery, they were significantly lower than those before surgery. High Ki-67 expression was significantly positively correlated with preoperative CTC counts. In addition, Ki-67 expression was higher in the high CTC group (≥ 5 CTCs). CONCLUSION: Our results suggest that surgical nephrectomy is associated with a decrease in CTC counts in RCC patients. CTCs can act as a potential biomarker for the diagnosis and prognosis of RCC. A careful and sufficient long-term follow-up is needed for patients with high preoperative CTC counts.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Células Neoplásicas Circulantes , Biomarcadores Tumorais , Carcinoma de Células Renais/cirurgia , Humanos , Antígeno Ki-67 , Neoplasias Renais/cirurgia , Prognóstico
9.
Transplant Proc ; 53(5): 1445-1449, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33962772

RESUMO

BACKGROUND: Nephron-sparing surgery is required for patients with kidney transplant with organ-confined renal cell carcinoma (RCC) in the allograft kidney to preserve renal function. Robot-assisted laparoscopic partial nephrectomy (RAPN) is expected to be the optimal surgical approach for these patients, as in the general population. However, RAPN for RCC arising in the allograft kidney is rarely reported. Here, we report 2 cases of patients who underwent RAPN for allograft RCC. CASE PRESENTATION: Two patients were diagnosed with RCC in the renal allograft based on enhanced computed tomography findings. Case 1 was a 69-year-old man with a 32-mm mass in the middle portion of the right iliac fossa renal allograft, and case 2 was a 55-year-old man with a 24-mm mass in the lower pole of the right iliac fossa renal allograft. In each patient, RAPN was performed for the renal mass through a transperitoneal approach, with clamping of the renal artery. No major perioperative complications occurred in either patient, negative surgical margins were achieved, and no significant changes in kidney function were observed during either surgery. Pathologic findings showed clear cell RCC in case 1 and papillary RCC in case 2. CONCLUSION: RAPN can be a feasible and effective treatment option for allograft RCC.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Idoso , Carcinoma de Células Renais/patologia , Humanos , Rim/patologia , Neoplasias Renais/patologia , Transplante de Rim , Laparoscopia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos , Tomografia Computadorizada por Raios X , Transplante Homólogo
10.
Cancer Causes Control ; 32(7): 675-680, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33963938

RESUMO

PURPOSE: Cytoreductive nephrectomy (CN) has played a role in treatment of metastatic renal cell carcinoma (mRCC) since trials demonstrated a survival benefit in patients receiving CN with interferon. With the publication of CARMENA, it became clear that the value of CN may depend on the co-therapy administered. We sought to assess the benefit of CN in the era of modern immunotherapy (IO). METHODS: We performed a systematic review to identify studies assessing CN in patients receiving TT or IO. We extracted multivariable-adjusted hazard ratios for the association between CN and overall survival (OS) and performed random effects meta-analysis. We tested for effect modification by systemic therapy approach on the association between CN and OS by pooling the difference in logHR associated with CN for patients treated with TT versus IO. RESULTS: We identified three comparisons assessing CN in patients receiving TT or IO. Pooled analysis indicated improved survival with CN in both the TT (2 cohorts, pooled HR: 0.52, 95% CI 0.46-0.59; I2 = 80%) and IO era (2 cohorts; pooled HR: 0.28, 95% CI 0.16-0.49; I2 = 21%), with a stronger association in the IO era (p = 0.01; I2 = 0%). CONCLUSION: In observational datasets, we observed a larger survival benefit to CN in patients treated with IO-based regimens versus those treated with TT-based regimens. While the role of CN for patients receiving TT has recently been questioned, this suggests that the results of CARMENA do not necessarily preclude a benefit to CN when combined with IO-based regimens.


Assuntos
Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/cirurgia , Procedimentos Cirúrgicos de Citorredução/métodos , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Terapia Combinada , Feminino , Humanos , Imunoterapia/métodos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Terapia de Alvo Molecular/métodos , Sobrevida
11.
Eur J Radiol ; 141: 109777, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34020173

RESUMO

The wide availability of cross-sectional imaging is responsible for the increased detection of small, usually asymptomatic renal masses. More than 50 % of renal cell carcinomas (RCCs) represent incidental findings on noninvasive imaging. Multimodality imaging, including conventional US, contrast-enhanced US (CEUS), CT and multiparametric MRI (mpMRI) is pivotal in diagnosing and characterizing a renal mass, but also provides information regarding its prognosis, therapeutic management, and follow-up. In this review, imaging data for renal masses that urologists need for accurate treatment planning will be discussed. The role of US, CEUS, CT and mpMRI in the detection and characterization of renal masses, RCC staging and follow-up of surgically treated or untreated localized RCC will be presented. The role of percutaneous image-guided ablation in the management of RCC will be also reviewed.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Imageamento por Ressonância Magnética Multiparamétrica , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Meios de Contraste , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia
12.
Am J Case Rep ; 22: e931696, 2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-33956773

RESUMO

BACKGROUND One-third of renal cell carcinoma cases present with an initial metastasis to various organs, emphasizing the tumor's unpredictable behavior. Prognosis is poor once metastasis is discovered. Multiple-organ involvement with metastatic lesions has a particularly dismal survival rate. Surgical resection alone of metastatic masses can extend patient survival with reasonable quality of life. CASE REPORT Here, we present the case of a healthy 46-year-old woman who initially presented with an incidental localized clear cell renal cell carcinoma. During the follow-up period, she presented with sequential asynchronous metastasis to the pancreas, thyroid, skin, contralateral kidney, and lung. She has no family history of malignancy. Her physical examination and laboratory investigations were normal even upon presentation of most of her metastatic organs. The first metastasis was in her sixth year of follow-up. She underwent consecutive metastasectomy of all the organs described above, excluding the lung. She eventually was started on sunitinib after non-resectable lung nodules were discovered. Her survival is now over 10 years since her first metastasectomy, with good performance status. CONCLUSIONS Metastasis to a single organ has a poor prognosis and dramatically affects survival. Nevertheless, our patient had multiple consecutive examples of metachronous metastasis, yet she has survived for over a decade since the occurrence of metastasis. Our case offers more information to fill the gaps in understanding the favorable role of surgical resection in advanced renal cell carcinoma metastasis.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Metastasectomia , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Rim , Neoplasias Renais/cirurgia , Pulmão , Pessoa de Meia-Idade , Pâncreas , Qualidade de Vida , Glândula Tireoide
13.
Clin Imaging ; 76: 199-204, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33964597

RESUMO

PURPOSE: Percutaneous ablation is an established alternative to surgical intervention for small renal masses. Radiofrequency and cryoablation have been studied extensively in the literature. To date, series assessing the efficacy and safety of microwave ablation (MWA) are limited. We present a cohort of 110 renal tumors treated with MWA. METHODS: A review of the medical record between January 2015 and July 2019 was performed, retrospectively identifying 101 patients (110 tumors). All ablations were performed by a single board-certified urologist/interventional radiologist. Demographic information, intraoperative, postoperative, and follow-up surveillance data were recorded. RESULTS: Median (IQR) age was 69.7 years (60.8-77.0); 27 (24%) were female. Median (IQR) BMI was 27.0 (25.1-30.2) and Charleston Comorbidity Index was 5.0 (4.0-6.0). 82 tumors were biopsy-confirmed renal cell carcinoma/oncocytic neoplasms. Median (IQR) tumor size was 2.0 cm (1.5-2.6). Median (IQR) RENAL nephrometry score was 6.0 (5.0-8.0). Technical success was achieved in all patients and all but one patient were discharged on the same day. Median (IQR) eGFR at baseline and 1 year were 71.9 mL/min/1.73 m2 (56.5-82) and 63.0 mL/min/1.73 m2 (54.0-78.2); the difference was -5.3 (p = 0.12). Two Clavien-Dindo type-I complications, one type-II complication, and one type-III complication were experienced in this cohort. Median radiographic follow-up was 376.5 days with 2 tumors (2.4% of RCC/oncocytic neoplasms) having recurred to date. CONCLUSIONS: MWA is a safe and efficacious treatment option for small renal masses with minimal adverse events and low rates of recurrence in this cohort of 101 patients. Continued follow-up is needed to assess long-term outcomes.


Assuntos
Carcinoma de Células Renais , Ablação por Cateter , Neoplasias Renais , Idoso , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Masculino , Micro-Ondas , Recidiva Local de Neoplasia , Estudos Retrospectivos , Resultado do Tratamento
14.
Clin Imaging ; 76: 205-212, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33964598

RESUMO

PURPOSE: To evaluate the safety and efficacy of preoperative renal artery embolization of renal cell carcinoma in reducing intraoperative blood loss during subsequent partial nephrectomy through a systematic review and meta-analysis of current literature. MATERIALS AND METHODS: The PubMed database was searched for articles published from 1970 to 2018 describing patients with renal cell carcinoma who underwent partial nephrectomy with and without preoperative embolization of the tumor. Demographic data, procedural techniques, and surgical outcomes were obtained when available. A random-effects meta-analysis was performed to determine estimated blood loss in both groups of patients. RESULTS: The literature search identified 14 relevant articles for systematic review, of which 4 articles provided sufficient data to be included in the meta-analysis. 270 patients (173 males, 97 females) underwent partial nephrectomy for RCC, of whom 222 received pre-operative embolization. There were 48 patients in our cohort that underwent partial nephrectomy for RCC without preoperative embolization. Random-effects meta-analysis demonstrated a significant difference between EBL in patients undergoing RAE prior to partial nephrectomy vs partial nephrectomy without preoperative embolization, with EBL of 154.0 ± 22.6 mL (n = 222) and 353.4 ± 69.6 mL (n = 478), respectively (p < 0.0001). Major complications occurred in 4.9% of patients undergoing pre-operative embolization followed by partial nephrectomy, whereas major complications occurred in 10.9% of patients undergoing partial nephrectomy without embolization (p = 0.01). Minor complications occurred in 5.8% of patients undergoing embolization and partial nephrectomy and in 19.0% of patients undergoing partial nephrectomy without embolization (p < 0.0001). CONCLUSION: Renal artery embolization prior to surgical resection of renal cell carcinoma is safe and significantly reduces intraoperative blood loss in patients undergoing partial nephrectomy.


Assuntos
Carcinoma de Células Renais , Embolização Terapêutica , Neoplasias Renais , Carcinoma de Células Renais/cirurgia , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Neoplasias Renais/cirurgia , Masculino , Nefrectomia , Artéria Renal , Resultado do Tratamento
15.
J Med Case Rep ; 15(1): 309, 2021 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-34051835

RESUMO

BACKGROUND: Clear cell renal carcinoma is known for its propensity for metastatic spread. Common sites of metastasis are the lungs, bones, lymph nodes, liver, adrenals and brain, but all organs can be affected. Contralateral ureteral metastasis is a rare phenomenon, and only a few cases have been reported in the literature. CASE PRESENTATION: We present the case of a 58-year-old Caucasian patient with a single contralateral ureteral metastasis of a clear cell renal carcinoma. CONCLUSION: Ureteral metastasis of clear cell renal carcinoma is very rare, and there is no well-established treatment. For patients with low metastatic spread/volume, the aim should be to preserve kidney function, and thus metastasectomy should be considered.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Metastasectomia , Ureter , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Linfonodos , Pessoa de Meia-Idade , Ureter/diagnóstico por imagem , Ureter/cirurgia
16.
BMJ Case Rep ; 14(5)2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-33990296

RESUMO

We report the case of a 50-year-old Tibetan man who presented to an outpatient urology clinic after abdominal ultrasound for poorly defined abdominal pain demonstrated horseshoe kidney (HK) with a right moiety ~3.7 cm mass further characterised using contrast-enhanced CT scan (CECT). This dedicated imaging confirmed HK with a heterogeneously enhancing right upper pole 3.1 cm×3.7 cm×2.7 cm mass. Due to suspicion for aberrant vasculature on CECT, renovascular angiography was performed, which revealed recruitment of a right paravertebral vessel alongside two right renal moiety arteries and multiple right renal moiety veins. Based on vascular complexity and the surgical exposure required for arterial clamping, open transperitoneal right partial nephrectomy was preferred to minimally invasive techniques. Postoperative course was complicated by ileus, which resolved with standard management. Pathologic analysis revealed complete resection of a 5.0 cm Fuhrman grade II clear cell renal cell carcinoma.


Assuntos
Carcinoma de Células Renais , Rim Fundido , Neoplasias Renais , Laparoscopia , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Rim Fundido/complicações , Rim Fundido/diagnóstico por imagem , Rim Fundido/cirurgia , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia
17.
Rozhl Chir ; 100(2): 88-93, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33910342

RESUMO

INTRODUCTION: Renal cancer is unique for many reasons. One reason is that renal cell carcinoma can grow directly into the drainage veins of the kidney, which enter the inferior vena cava leading to the heart. This growth of tumor cells into the veins is called a tumor thrombus and is a locally aggressive renal cancer. The present article informs about the experience of our cardiac surgery department together with the transplant surgery department in successful surgical removal of a kidney with tumor, with invasion into the inferior vena cava, right atrium of the heart and pulmonary artery in two case reports. CASE REPORTS: A 32 years old female without significant history, with suddenly evolving dyspnea was urgently admitted to hospital. Her condition was suspected to be caused by pulmonary artery embolisation. The diagnosis was confirmed by CT scan which revealed unknown tumor mass of the right kidney and tumor embolisation in inferior vena cava and pulmonary artery. The patient was urgently operated by a vascular surgeon and cardiothoracic surgeon. They successfully performed left radical nephrectomy and total thromboembolectomy of the tumorous masses from vena cava inferior and pulmonary artery. The postoperative course was without complications, postoperative CT revealed no residual masses, and the patient was discharged in a good condition from the hospital. A 58 years old male with arterial hypertension suffered from orchiepididymitis. CT scan showed a tumor of the left kidney with propagation of tumorous masses to inferior vena cava and pulmonary artery. In elective surgery the vascular surgeon and cardiothoracic surgeon successfully performed left radical nephrectomy with total thromboembolectomy of the tumorous masses from inferior vena cava and pulmonary artery. After surgery a temporary paralytic ileus and an episode of atrial fibrillation occurred. Both are common postoperative complications related to the given surgical procedure. Follow-up CT scan showed no residual tumor or thrombus in inferior vena cava and pulmonary artery. Echocardiography revealed persistent dilation of right compartments of the heart with good systolic functions of both ventricles. The patient was discharged from hospital in a good condition. CONCLUSION: Surgical removal of renal tumor and tumor thrombus - radical nephrectomy with tumor thrombectomy - can be a curative treatment and can ensure long-term survival of the patient. Depending on the extent of the tumor thrombus, these operations can be performed in different ways - mini-invasive, robotic or open. When open surgery is used, it is possible to perform the procedure with or without extracorporeal circulation (cardiopulmonary bypass - CPB) depending on the extent of the disease.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Embolia Pulmonar , Adulto , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Trombectomia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
18.
J Vasc Interv Radiol ; 32(4): 544-547, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33795074

RESUMO

This report evaluates the techniques and complications of microwave ablation of cystic renal cell carcinoma. Five patients with cystic renal cell carcinoma were treated with microwave ablation between October 2015 and June 2020. Medical records were reviewed to evaluate technique and complications. Technical success and primary technique efficacy both were 100%. There were no complications. Mean follow-up time was 18 months (range, 6-36 months). No local recurrence was identified during the follow-up period. Renal function remained stable at 1 month and the last follow-up. Percutaneous microwave ablation is promising for the nonsurgical management of cystic renal cell carcinoma.


Assuntos
Técnicas de Ablação , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Micro-Ondas/uso terapêutico , Neoplasias Císticas, Mucinosas e Serosas/cirurgia , Radiografia Intervencionista , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X , Técnicas de Ablação/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Masculino , Micro-Ondas/efeitos adversos , Neoplasias Císticas, Mucinosas e Serosas/diagnóstico por imagem , Neoplasias Císticas, Mucinosas e Serosas/patologia , Valor Preditivo dos Testes , Radiografia Intervencionista/efeitos adversos , Estudos Retrospectivos , Cirurgia Assistida por Computador/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
19.
In Vivo ; 35(3): 1573-1579, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33910838

RESUMO

BACKGROUND: In cT1 renal cell carcinoma (RCC), very few studies have compared oncological outcomes and renal function preservation rates in nephron-sparing robot-assisted partial nephrectomy (RAPN) and percutaneous cryoablation (PCA). PATIENTS AND METHODS: We retrospectively analysed 126 patients with cT1 RCC treated with RAPN (n=78) and computed tomography-guided PCA (n=48) between March 2016 and November 2019. Clinical data and outcomes were compared for the two groups. RESULTS: There were no significant differences in the 3-year overall survival and relapse-free survival rates in the two groups (p=0.17 and p=0.093, respectively). The median percentage of estimated glomerular filtration rate preservation at 6 months after surgery was 91.8% and 91.4% in the RAPN and PCA groups, respectively (p=0.9). CONCLUSION: In patients with cT1a RCC, oncological outcomes and renal function appear similar following RAPN and PCA.


Assuntos
Carcinoma de Células Renais , Criocirurgia , Neoplasias Renais , Robótica , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/cirurgia , Recidiva Local de Neoplasia , Nefrectomia , Estudos Retrospectivos , Resultado do Tratamento
20.
Medicina (Kaunas) ; 57(3)2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33804740

RESUMO

Background and objectives: Cryoablation is emerging as a safe and effective therapeutic option for treating renal cell carcinoma. This study analyzed the safety and long-term oncological outcomes of cryoablation in our center. Materials and methods: Patients who underwent computed tomography (CT)-guided percutaneous cryoablation between February 2011 and June 2020 for one or more clinically localized renal tumors were identified. Technical success and treatment efficacy were assessed. Post-procedural complications were classified according to the Clavien-Dindo system. Recurrence-free survival was determined for biopsy-proven malignant renal tumors. Results: A total of 174 renal tumors, 78 of which were biopsy-proven malignant carcinomas, were treated in 138 patients (97 males and 41 females, mean age: 73 years, range: 43-89 years). Mean tumor size was 2.25 cm and 54.6% of the lesions required a complex approach. Technical success was achieved in 171 out of 174 tumors (98.3%). Primary treatment efficacy was 95.3% and increased to 98.2% when retreats were taken into account. The overall complication rate was 29.8%. No complications of Clavien-Dindo grade III or more were encountered. Median follow-up was 21.92 months (range: 0.02-99.87). Recurrence-free survival was 100% at 1 year, 95.3% (95% CI: 82.1%-98.8%) at 3 years, and 88.6% (95% CI: 71.8%-95.7%) at 5 years. Conclusions: Cryoablation is a safe and effective technique for the treatment of small renal lesions, with no major complications when performed by expert interventional radiologists. The multidisciplinary discussion is essential, especially considering the high number of histologically undetermined lesions. Our long-term oncological outcomes are encouraging and in line with the literature.


Assuntos
Carcinoma de Células Renais , Criocirurgia , Neoplasias Renais , Idoso , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Criocirurgia/efeitos adversos , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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