Surgical Enucleation for the Treatment of Renal Tumors

Abstract

Introduction: We analyzed our institutional experience with surgical enucleation for the primary treatment of small renal tumors. Materials and Methods: Patient demographics, histological features, effect of different types of vascular control and outcome from surgery were analyzed in 45 patients. A majority of the tumors (67%) were diagnosed incidentally. Results: All were stage T₁, 77% were low grade (I–II) and 23% were high grade (III–IV). Complication occurred in 12% of patients. At a mean follow-up of 34 months (range 7–97), 28 of 33 patients (84%) with malignant tumors were alive without evidence of disease. One patient with a solitary kidney developed recurrent tumor after enucleation that required nephrectomy. Mean operative time was significantly lower with the compression technique versus direct vascular control (164 ± 12 min vs. 233 ± 15 min, p = 0.002). There were no differences in outcome between the two techniques. Conclusions: Surgical enucleation is a safe and viable procedure for the treatment of small renal tumors. Manual compression of the kidney appears to be at least as effective as clamping of the renal vessels in obtaining vascular control during the procedure and is more expeditious.

Enucleation of renal cell carcinoma with ablation of the tumour base

“…In 2003, Franks et al. [12] reported on 45 patients who had undergone excision of tumour with a 0.5–2 cm margin, and were followed for a mean of 34 months; 49 tumours were resected and 12 (24%) were found to be benign. The mean (range) tumour size was 2.9 (1.1–6.1) cm; the tumour bed was not ablated.…”

“…However, clinical evidence from surgical series suggests that a 1-cm margin is excessive. Contemporary clinical data indicate that margin size has no measurable effect on the clinical outcome [4,7,[10][11][12][13][14][15][16].…”

Coil embolization for treatment of vascular complications after nephron-sparing surgery

“…Thanks to ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), the frequency of renal tumors detected incidentally is rising (1). Nephronsparing surgery (NSS) -covering enucleation, wedge resection, or partial nephrectomy -is commonly used to treat small renal tumors (,4 cm in diameter) (2) and is an option for patients with a solitary kidney, bilateral tumors, or renal insufficiency (2,3). Here, open NSS is the gold standard (4), because it offers long-term preservation of renal function and is associated with recurrence-free survival rates equivalent to those of radical nephrectomy (5).…”