To elucidate the feasibility of surgical enucleation, the incidence of extracapsular tumor invasion in 30 cases of renal cell carcinoma with a diameter less than 5 cm was examined, based on the classification of extracapsular tumor invasion into three patterns, namely microinvasion, nodular invasion, and daughter tumors. Of the 30 cases of renal cell carcinoma, 22 cases (73%) revealed extracapsular tumor invasion. And the incidence of microinvasion, nodular invasion and daughter tumors was 7 cases (23%), 9 cases (30%) and 6 cases (20%), respectively. But the incidence of these three patterns of extracapsular tumor invasion correlated neither with the size of renal cell carcinoma nor with pT classification. There was a tendency for extracapsular tumor invasion to occur near the renal hilar site of the renal cell carcinoma, where the tumor vessels were rich, penetrated and twined around the tumor capsule, resulting in the disruption of the tumor capsule. These three patterns of invasion was located within 1 cm in distance from the tumor capsules in all cases. In conclusion, because of limited radicality achieved by tumor enucleation even in the case of pT1, partial nephrectomy was recommended in the presence of a normal contralateral kidney.
To evaluate the significance of preoperative transvascular embolization in the radical nephrectomy, thirty-seven patients with renal cell carcinoma underwent transvascular embolization followed by radical nephrectomy one day after. Thirty-five cases became available for clinicopathological examination with reference to the perioperative blood loss, duration of operation and prognosis, comparing to those of twelve cases with nephrectomy alone.The degree of renal infarct induced by embolization was divided into four groups by the extent of cortical necrosis sparing the subcapsular areas, which was the histologic characteristic about 24 hours after the embolization.Among 35 cases with embolization, 18 cases (51. 4%) were grouped into Grade N, 10 cases (28. 6%) into Grade 111, 3 cases (8. 6%) into Grade II and 4 cases (11. 4%) into Grade I. Thus, it was proved that the renal infarct induced by embolization was various in extent about 24 hours after the embolization. And comparing the grade of renal infarct with the degree of radiological occlusion by viewing the progress of contrast medium, there was no definite mutual relation between them. Also, there was no mutual relation between the kind of embolant and the grade of renal infarct.Although embolization could make less significant decrease in the blood loss and duration of the operation, the blood loss of the Grade N group in embolization was proved to be least.The survival rate after embolization and nephrectomy was better than after nephrectomy alone, in particular, the survival rate of Grade N group was excellent.Our study demonstrated that it was important for getting better perioperative effect and prognosis to occlude the renal arterial flow completely by embolization, resulting in prohibiting the release of tumor cells from the primary site and the metastasis.
We treated ten patients with carcinoma in situ of the bladder (primary type, 6 and secondary type, 4) by intravesical bacillus Calmette-Guerin therapy. All patients received 8 weekly instillation, and among them 3 patients were followed by additional instillation monthly for 7 months. Complete regression (negative biopsies and cytology study) was observed after 8 weekly instillation in all patients. To elucidate the mechanism of action of BCG on carcinoma in situ, the biopsied specimens after BCG instillation were examined light and electronmicroscopically. It was speculated that BCG might act on cancer cells in two ways: one was sloughing and denudation of the cancer cells by acute tuberculous cystitis, and the other was a role of the macrophages through immune reaction. In our study, the toxicity and complications seemed to be much severer than previously reported. Vesicoureteral reflux was observed in 6 patients. Decreased bladder capacity noted in all patients, among them radical cystectomy and colocystoplasty were performed in 2 patients under the diagnosis of bladder contracture. Although complete regression was observed in all patients after 8 weekly BCG instillation, the duration being free from cancer cells was variable. And we also discussed on the additional therapy in such patients in the literature.
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