Enucleoresection for the Elective Treatment of Small Renal Cell Carcinoma: Can It Be the Treatment of Choice?

Abstract

Background: We present our findings in a series of T1 renal cell carcinomas (RCC) treated with excision of the tumor surrounded by a minimal layer of grossly normal parenchyma. Patients and Methods: A total of 43 patients who underwent elective nephron-sparing surgery performed with enucleoresection were studied retrospectively. None of the patients had preoperative or intraoperative suspicion of positive nodes and were free from distant metastases before surgery (N0, M0). Patients status was last evaluated in January 2006. Results: Median age was 58.7 years (35-78). Median tumor size was 3.3 cm (1.5-7). There were no major complications such as bleeding and urinary leakage/ urinoma requiring re-operation. Pathological stage was pT1a in 38 (89%), pT1b in 4 (9%) and pT3a in 1 (2%) patient. Median followup was 32 months (6-89). A total of 5 patients with RCC had died as of January 2006. Overall, 3 (6.9%) patients had disease progression, of whom 2 (4.6%) were local recurrence, 1 alone and 1 associated with distant metastases. The overall cancer-specific survival was 95.4%, and the overall progression-free survival was 93%. Conclusions: Enucleoresection reproduces the results of partial and radical nephrectomy with minimal morbidity. It is a safe and acceptable approach for elective nephronsparing surgery.

Primary Renal Epithelioid Hemangioendothelioma

“…The European Association of Urology Clinical Guidelines on renal cell carcinoma (RCC) suggest that nephronsparingsurgeryisanestablishedstandardcurativeapproach forthetreatmentoftumorsupto4cm(andfeasiblefortumorsupto7cm)thatprovidesrecurrence-freeandlong-term survivalratessimilartothoseofpatientssubjectedtoradical nephrectomy [9].Inanexcellenteditorial,Russo [10]underlinedthataccumulatingclinicalevidenceindicatesthatpartial nephrectomy provides equally effective local tumor control asradicalnephrectomydoeswiththeadvantageoflong-term preservation of renal function. In addition, Adamakis et al [11]showedthatenucleoresectionisasafeandacceptableapproach for elective nephron-sparing surgery with outcomes similartothoseofradicalnephrectomy.Theoverzealoususe of radical nephrectomy for small renal tumors must now be consideredsurgicaloverkillaswellasdetrimentaltothelongtermhealthandsafetyofthepatientwithasmallrenalcortical tumor [10].Furthermore,usinganephron-sparingapproach, there is no need for intraoperative frozen section biopsy of the tumor since the kidney is preserved. However, it should behighlightedthatincasesoflargersizetumorsthefollowupshouldbeintensifiedduetoanincreasedriskofintrarenal recurrences [9].Therapeuticapproachesforrecurrenttumors includecompletionnephrectomy,repeatpartialnephrectomy, and more recently ablative techniques such as cryoablation andradiofrequencyablation [12].…”

Pretreatment with Interferon-a2a Modulates Perioperative Immunodysfunction in Patients with Renal Cell Carcinoma

“…Approximately 20% of the patients present with metastatic disease, and 20-30% of patients who undergo curative surgery for localised (N0M0) RCC will develop metastatic disease [2][3][4][5]. Only a small number of patients with metastatic disease can be cured by existing therapies.…”

Tumor enucleoresection in robot-assisted partial nephrectomy

“…They concluded that the results of partial nephrectomies with minimal normal parenchyma around the tumor are not inferior to the studies with widely excised partial nephrectomies found in the literature. Adamakis et al [14] also describe a similar technique on 43 patients, that reproduces the results of partial and radical nephrectomy with minimal morbidity. We have tried to develop the technique even more and apply it to minimal invasive robotic partial nephrectomy.…”