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Year : 2016  |  Volume : 8  |  Issue : 5  |  Page : 8-15  

Renal Cancer

Date of Web Publication18-Dec-2015

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How to cite this article:
. Renal Cancer. Urol Ann 2016;8, Suppl S1:8-15

How to cite this URL:
. Renal Cancer. Urol Ann [serial online] 2016 [cited 2020 May 27];8, Suppl S1:8-15. Available from: http://www.urologyannals.com/text.asp?2016/8/5/8/172182

Different approaches to renal malignancies in Riyadh central hospital

Adel M. R. Youssef, Saleh O. El Mohalhel, Ahmed H. Moabed

Urology Department, Riyadh Central Hospital, Riyadh, Saudi Arabia

Over the last four years, 52 renal tumours were diagnosed and treated at our hospital. Of these, 40 were tumours kidney proper and twelve collecting system tumours, all of these last type were transitional cell malignancies. The others were 2 Wilm's, 3 papillary carcinoma, one sarcoma, one oncocytoma, and one hamartoma, one bilharzial mass, and the remaining 31 were clear cell carcinomas.

Our main dependency for definitive diagnosis has been on U/S and CT, and recently we depend rarely on angiogram in selective cases.

The treatment of choice has been radical nephrectomy for the proven kidney tumours, and nephroureterectomy for collecting system ones.

But we have also done embolization for 3 cases and surgical ligation for one case, but no enucleation or partial nephrectomy for any case despite the recent publications advocating these methods in special situations, that is except in one case due to an error in judgement.

And our results covering these cases justifies our commitment.

Presented at the: 5 th Saudi Urological Conference

King Fahd Military Medical Complex

22-23 March 1989

Renal neoplasia: 5 years experience at Riyadh armed forces hospital

A. Jamal, M. S. Abomelha, K. Etaibi

Urology Division, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

Between 1981-1986, thirty patients with renal tumours were treated at the Urology Department of the Riyadh Armed Forces Hospital. The average age of diagnosis was 52 years. The mean follow up period was 14 months. Male:Female ratio was 3:1. Pain was present in 80% of patients. Ultrasound was the most sensitive preliminary diagnostic evaluation and was positive in 70% of cases, while intravenous urogram was positive in 60% of cases.

Nephrectomy was performed in 27 patients. One patient had renal embolisation, one patient refused surgery and an elderly one was unfit for surgery.

Of the nephrectomised patients, 19 (63%) had renal cell carcinoma, two (7%) had transitional cell carcinoma, two (7%) has squamous cell carcinoma, two (7%) had renal adenoma and two (7%) had oncocytoma.

With the two benign oncocytoma excluded proper staging was performed in 26 patients. Here 13 patients (50%) had Stage I tumours, two (8%) Stage II, one (4%) Stage IIIA, and the remaining ten patients (38%) belonged to the Stage IVB.

Presented at the: 5 th Saudi Urological Conference

King Fahd Military Medical Complex

22-23 March 1989

Management of renal carcinoma at K.H.M.C

Haken Al-Kadi, N. Younis, F. Musa, N. Haddad, R. Abouzeid

Department of Urology, King Hussein Centre, K.H.M.C., Amman, Jordan

A review of kidney tumours operated on at King Hussein Medical Centre over a period of 10 years. Revealed a total number 81 tumours which constituted a 25% nephrectomies done for different reasons which constituted 1.6% of all pathology specimens received during the same period.

Analysis of 61 kidney tumours revealed 43 (70%) clear cell carcinoma, 12 (20%) transitional cell carcinoma, 3 (5%) lymphomas, and 3 (5%) cortical adenoma.

Male:Female ratio was 3:1.

The peak age incidence 50 years average age - range 24-75 years distribution of tumour site, staging of tumour, and presentation of tumours is presented. Survival rate for different tumour type and stage is analysed and presented.

Presented at the: 5 th Saudi Urological Conference

King Fahd Military Medical Complex

22-23 March 1989

Renal neoplasia: Five years experience at armed forces hospital, Jeddah, Saudi Arabia

A. Garoushe, S. D. Balawy

Urology Department, Armed Forces Hospital, Jeddah, Saudi Arabia

Between 1985 and 1990, 11 patients with renal tumors were treated at the Armed Forces Hospital, Jeddah. Age at presentations ranged between 12 and 100 years. The main presenting symptoms were loin pain and hematuria in 70%. Incidentally, in three cases (27.5%), (the diagnosis was made for non-urological complaints). Ultrasound was accurate and widely available screening test, and was positive in approximately 80% of our cases. CT scan is valuable for staging and confirming the origin of the tumor.

10 patients were operated on successfully, nine were renal cell carcinoma including a child of 12 years old, and one oncocytoma. In spite of this small series, incidental findings of renal cell carcinoma carries a better prognosis, in view of this early detection. We encourage a wider use of ultrasound, with inclusion of kidneys, in upper abdominal screening.

Presented at the: 6 th Saudi Urological Conference

National Guard King Khalid Hospital - Jeddah

27-28 November 1991

Survival and prognostic factors in renal cell carcinoma: A ten year review, 1985-1995

R. Talic, S. El Faqih

Department of Urology, King Khalid University Hospital, Riyadh, Saudi Arabia

Seventy-eight patients with renal tumors were managed in our institution over the last 10 years. Thirty-two of these were Saudi patients with renal cell cancer; a retrospective review to study the survival pattern and prognostic variable that might have influence the outcome of their management was carried out. The group comprised 18 male and 14 female patients with a mean age of 50.9 +/- 14.5 years. Thirty-one patients were followed up for an average of 33 months (range 3-120). Patients with stage I, II and III disease had a five year survival of 95% in comparison to 15% for stage IV disease; this marked difference in survival was statistically significant (P=0.0001). The survival was also significantly different according to tumor size (P=0.005); the five year survival was 95% for patients with tumors less than 10 cm in size compared to 25% for patients with tumors greater than 10 cm. Age, sex, clinical presentation and pathological features of the tumors were analyzed for their significance as prognostic factors. The multivariate analysis by proportional hazard model showed two important and independent prognostic variables: the anatomic extent of the tumor (P=0.02) and tumor size (P=0.033).

Presented at the: 10 th Saudi Urology Conference

King Fahad National Guard Hospital

26-28 November 1996

Considerations in the management of unilateral and bilateral nephroblastoma

Nabil K. Bissada, Kwesi Sackey

Surgery and Oncology Departments, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Surgery, radiotherapy, and chemotherapy are currently utilized in the management of children with nephroblastoma (Wilm's Tumor). Fifty-three patients with unilateral and 9 with bilateral nephroblastoma were managed at the King Faisal Specialist Hospital and Research Centre with combinations of surgical, radiotherapeutic, and chemotherapeutic measures. Peculiarities in the clinical presentation of these patients necessitated individualization of management.

Presented at the: 4 th Saudi Urological Conference

Riyadh Central Hospital

18 September 1986

Wilm's tumour

H. Farsi, H. Mosli

Urology Unit, King Abdulaziz University Hospital, Jeddah, Saudi Arabia

Wilm's is the most common renal neoplasm in infancy and childhood. Twelve patients with histologically confirmed diagnosis of Wilm's tumour were treated at K.A.U.H. over 4 years period. Although 2/3 of our patients presented with stage 2 and 3, the use of combination therapy gave a survival percentage similar to that reported from Western Centers.

Presented at the: 5 th Saudi Urological Conference

King Fahd Military Medical Complex

22-23 March 1989

Surgical management of bilateral synchronous Wilm's tumors

M. M. El Gammal, N. K. Bissada, K. A. Hanash, K. Sackey

Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

In this communication, we report on the surgical management of 11 consecutive patients with bilateral synchronous Wilm's tumor (Stage V) treated at KFSH since 1976.

All patients, mean age 24 months, had surgical resections of tumors and/or biopsy and all received combination chemotherapy. Tumor removal, entirely or in part, was possible in 3 of the 11 patients (27%) at initial operation. All gross disease was excised in 6 patients (54%) at one or more operations. Of the 22 kidneys at risk, only 7 (the most involved side) were removed at the initial operation and no nephrectomy was needed at a subsequent surgery. Eight kidneys were treated by partial resection, and four patients had bilateral renal preserving procedures.

Out of the 11 patients, 7 are alive with normal serum creatinine and free of disease (mean follow up 4 years and 5 months). Two were lost to follow up at 32 months and 2 months, and two died, one from radiation nephritis and one from disseminated Wilm's Tumor with sepsis.

We conclude that conservative renal sparing surgery and combination chemotherapy offer a favorable outcome in patients with bilateral synchronous Wilm's Tumor.

Presented at the: 5 th Saudi Urological Conference

King Fahd Military Medical Complex

22-23 March 1989

Wilm's tumour: Outcome in 22 cases

S. A. Orkubi, M. Mecci, A. A. Shaaban, K. E. Al Otaibi, M. T. Said, M. S. Abomelha

Department of Urology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

In a retrospective study, we present the results of 22 children with Wilm's tumour treated at Riyadh Armed Forces Hospital between January 1983 and June 1993.

Their ages ranged from 5 days to 7 years. We placed the children into 2 groups according to their age at presentation. Group 1 included 9 patients <2 years of age (7 females and 2 males) and Group II with 13 patients >2 years of age (2 females and 11 males). All patients in both groups presented with an abdominal mass except for haematuria in one patient in Group II. Preoperative assessment included chest x-ray, intravenous pyelogram, ultrasound scan and CT scan; MRI and bone scan were used selectively.

National Wilm's Tumour Study (NWTS) system was used for staging. Group I included six patients with stage I, two patients with stage II and one with stage III tumours. Histology was favourable in all. In Group II we found one patient with stage I, two patients with stage II, six with stage III (including 2 operative spillage) and four patients with stage IV tumours. Histology was unfavourable. Treatment was individualised. Three patients from Group I and five patients from Group II received preoperative chemotherapy. Protocols used were NWTS until 1990 and UKCCSG after this.

All patients in Group I were in remission at 2 years follow up (100%). This did not include one infant who died following a stormy post operative period. In Group II, 12 out of 13 patients (92%) were in remission. One died following local recurrence.

In conclusion, multi-modality approach to the treatment of children with Wilm's tumour has significantly improved outcome. As we are well aware of late recurrences in Wilm's tumour, these patients require careful follow up well into adulthood.

Presented at the: 9 th Saudi Urology Conference

King Fahad Hospital - Jeddah

14-16 November 1995

Renal tumours: A review of 112 cases

A. M. Jad, M. S. Abomelha, M. T. Said, S. A. Orkubi, K. E. Al Otaibi

Department of Urology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

Between 1981 and 1997, 112 adult patients with renal tumours were treated in our department. The average age at diagnosis was 54 years (range 23-90). Male to female ratio was 2:1. Pain was the main presenting symptoms in 49% while haematuria and palpable mass were present in 38% and 30%, respectively. The classical triad was present in only 9%. It is worth to note that 28% of patients were diagnosed incidentally. All diagnostic tools were utilized including ultrasound, IVU, CT and bone scan, and in special cases angiography. 90% of the cases had radical nephrectomy, 4% simple or partial nephrectomy and 6% were not fit for surgery and had biopsy and/or embolization. The majority of renal tumours in 14%. Advanced stage (> III) were found in 39% at time of diagnosis. Most of the patients (94%) were followed up for a mean period of 16 months (range 3-99). While 75% of patients with advanced RCC died or progressed further, the majority of non-advanced RCC (89%) were cured.

We conclude that the majority of renal tumours were to RCC type. About one-third of the patients with renal tumour were diagnosed incidentally. The classical triad was present in only 9%. The prognosis of advanced RCC is poor, while majority of early RCC was cured by radical nephrectomy.

Presented at the: 12 th Saudi Urology Conference

Al Hada and Taif Armed Forces Hospital Program

23-25 February 1999

(7-9 Dhu Al Qa'dah 1419)

Competing modalities in small renal tumours, an update

Hassan Mesfer Al Zahrani

Urology Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

The incidence of asymptomatic incidental small renal tumors is increasing. This is attributed mainly to the availability of medical care and the wider use of imaging modalities like ultrasound, CT and MRI. While the natural history of small renal cell carcinoma is not often clear, surgical excision has been the standard treatment for decades. Elective nephron sparing surgery for such lesions has gained popularity with cancer control equal to the gold standard radical nephrectomy. The invasiveness and morbidity of partial nephrectomy has prompted interest in less invasive approaches. Laparoscopic partial nephrectomy is evolving as a less invasive approach. The procedure is technically challenging and complex. While cancer control at the short term is encouraging, the complication rate and the risk of positive margins limited its routine practice to few centers worldwide. In situ ablative techniques have recently been added to the management options of small renal tumors. The two potential modalities that have been used clinically are cryotherapy and radiofrequency (RF). Both techniques can be used percutaneously and laparoscopically with less invasiveness and morbidity. RF may also be used under intravenous sedation and local anesthesia. The reported results at the short and intermediate term are encouraging. They may be the future alternative to surgical extirpation especially in patients who are poor surgical candidates. The techniques are awaiting more optimization and data with longer follow up on cancer control. Other ablative modalities such as high intensity focused ultrasound (HIFU), interstitial laser and microwave thermal therapy are been tested at animal models or small pilot studies. With the increasing options to manage small renal tumor the approach of watchful waiting may be added especially in comorbid poor surgical candidates. Data on this approach justify its consideration in view of the uncertain natural history.

Presented at the: 17 th Saudi Urological Conference

King Fahd Military Medical Complex

8-10 March 2005

Long-term outcome of conservative and surgical management of renal angiomyolipoma: A single center experience

Raouf M. Seyam, Alaa A. Mokhtar, Muhammad Aslam, Walid A. Mourad,

Naser Elkum, Hassan M. Al Zahrani,

Said A. Kattan, Kamal A. Hanash

Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Purpose: Angiomyolipoma (AML) is a rare benign tumor affecting the kidney. We report on 35 cases followed for an average of 4 years.

Materials and Methods: We retrospectively reviewed the charts of AML patients. We compared patients with sporadic versus tuberous sclerosis complex (TSC) associated lesions and patients who underwent surgical versus conservative treatment.

Results: The median age at presentation was 45.8 years (11.6-68). The presenting symptom was pain (60%), incidentally discovered (22.9%) or hematuria (14.3%). Females constituted 77.1% of our patients. We had 6 (17.1%) TSC patients. The median size of the lesions was 5cm (0.3-40). Conservative treatment was undertaken in 54.3%. We performed nephrectomy in 22.9%, partial nephrectomy in 17.1%, and embolization in 5.7% of patients. The indication for surgical or interventional treatment was hemorrhage in 20%, suspicion of malignancy 17.1% and pain in 8.6%. Patients were followed up to a median of 39.5 months (1-145). A total of 88.6% remained asymptomatic. Overall, lesions grew an average of 1.9cm (SD=4.6). None of the patients developed renal impairment. Patients with TSC associated AML significantly presented at a younger age, had larger, bilateral lesions with higher growth rate and were more symptomatic at follow up. One TSC patient died of acute renal hemorrhage. Patients managed surgically had larger tumors at presentation.

Conclusions: Long-term observation of sporadic AML indicates slow growth rate and preservation of renal function. Better diagnosis to rule out malignancy, would avoid many surgical interventions. Management of TSC associated lesions remains a challenging problem.

Presented at the: 17 th Saudi Urological Conference

King Fahd Military Medical Complex

8-10 March 2005

Microvascular tumor invasion: Prognostic significance in low stage renal cell carcinoma

Khaled Madbouly, Saeed Mohammed Alqahtani, Muhammed Ashraf Ali, Mostafa Kamal Mansi

Department of Urology, King Fahad National Guard Hospital, Riyadh, Saudi Arabia

Objective: To evaluate the role of Microvascular Tumor Invasion (MVI) in clinical behavior and prognosis of low stage RCC.

Patients and Methods: A total of 48 patients (22 males and 26 females, mean age 50.7 years, range 20-80 years) underwent radical nephrectomy from 1990 to 2004. Only patients with clinically confined disease to the kidney (stages T1-T2, Nx Mo) and minimal follow up period of one year were included. Mean follow up period (SD) was 37.6 (18.2) months ranging from 12 to 60 months. All paraffin blocs obtained from surgical specimens were reviewed by a single pathologist (M.A.A.) as regards tumor diameter, cell type, perirenal fat invasion, macroscopic and microvascular invasion, neoplastic lymph node involvement and nuclear grade. Clinical staging was performed according to 1997 staging system and nuclear tumor grade was analyzed according to Fuhrman grading system. The Rochester classification was used for cell typing.

Results: Microvascular tumor invasion was encountered in 8 patients (16.7%), of whom 50% developed treatment failure in the form of distant metastases. Of the 40 patients without MVT, only 2 (5%) showed treatment failure. When treatment failure was correlated with different patients' and histological parameters, a significant statistical association was noted with patients' gender (p=0.006) and MVI (p=0.005). However, in multivariate analysis MVI only sustained an independent significant impact on treatment failure.

Conclusions: Microvascular invasion is an independent and relevant prognostic parameter for low clinical stage renal cell carcinoma.

Presented at the: 18 th Saudi Urological Conference

King Abdulaziz University Hospital

20-23 February 2006

(21-24 Muharram 1427)

Conservative management for localized renal cancer: Are there complimentary roles for immediate surgery, active urveillance with delayed treatment and the less invasive therapies?

Michael A. S. Jewett 1,2

1 Department of Surgical Oncology, Division of Urology, University Health Network (Princess Margaret Hospital), Ontario, Canada, 2 Canadian Urological Association, University of Toronto, Ontario, Canada

Malignant tumors of the kidney represent slightly more than 2% of new cancer cases and deaths. During the last 20 years the incidence of renal cell carcinoma (RCC) has been increasing worldwide, due in part to the widespread use of new and improved noninvasive abdominal imaging. The increasing incidence has occurred in all clinical stages, but the greatest increase has been observed in patients with localized tumors, suggesting stage migration as a result of earlier detection. In recent years, most of RCC's have been incidentally detected as small renal masses in asymptomatic patients. The natural history of small renal masses has not been adequately investigated because most are surgically treated soon after diagnosis by partial or radical nephrectomy. However, retrospective studies of Bosniak et al. suggested that tumors <3 cm in diameter rarely metastasize and have a slow growth rate. Other authors have reported that localized primary tumors have a clinically significant lower rate of growth if compared to either primary advanced or metastatic lesions. We have reported that the tumors that are destined to grow fast and possibly metastasize, do so early, while most small tumors grow at a low rate or not at all. About one third of small renal masses appear to grow significantly if managed conservatively with serial imaging. These observations raise the possibility of a period of initial observation in selected elderly or infirm patients with treatment reserved for those that have rapid doubling times or reach a size that has been demonstrated to be associated with an increased risk of progression. While we have not observed a patient who progressed to metastatic disease on active surveillance, this has been reported. Active surveillance with delayed treatment is not yet an appropriate treatment for younger and fit patients with small renal masses presumed to be renal cell carcinomas.

The standard of care for small localized renal tumors is either radical or partial nephrectomy. Nephron sparing surgery with partial nephrectomy for smaller renal cell carcinomas is increasingly popular as an alternative to radical nephrectomy. Laparoscopic partial nephrectomy is difficult but techniques are now being perfected. Therefore, it is now widely performed and is frequently perceived to be a preferred alternative to open partial nephrectomy. In general, surgery for renal tumors is more frequently performed, usually for small renal masses soon after diagnosis. The rationale is that early detection and treatment of a small tumor should lead to an improved cancer-specific prognosis. Although morbidity from nephrectomy has decreased with improved techniques, it is still significant and reported in 11 to 30% of cases in recent series.

There are a number of non-ionizing physical therapies that are being used clinically including cryotherapy and thermotherapy with radiofrequency (radiofrequency ablation or RFA) and ultrasonic energy sources. These minimally invasive techniques should reduce the risks and morbidity of open and laparoscopic surgery and may be preferable in elderly patients, patients with kidney failure or solitary kidney, significant comorbidities or who are likely to develop multiple renal tumors during their lifetime (e.g. VHL disease).

Cryoablation is the most well studied and clinically tested ablative technology. Clinical results in the treatment of small renal tumors are encouraging. It can be performed using open, percutaneous or laparoscopic approaches, but the percutaneous route seems to be the least morbid and therefore may become the preferred choice. Clinical experience with radiofrequency ablation is also interesting, but follow up data is relatively short.

The more recently introduced modalities for thermal ablation of kidney tumors, HIFU (High Intensity Focused Ultrasound) and LITT (Laser Induced Thermotherapy), appear to be effective but they should still be considered experimental until more data on the safety profile and clinical efficacy becomes available.

Reports on larger clinical series with longer follow up are required, but it is reasonable to assume that in the absence of effective biological therapies, ablation with energy sources delivered by extracorporeal means have the potential to replace open and laparoscopic techniques.

Because small renal masses may be benign, there is increasing interest in the use of percutaneous biopsy preoperatively. It appears to be safe and the technique is well described. The accuracy is improving and this diagnostic tool will be increasingly embraced by urologists.

Presented at the: 18 th Saudi Urological Conference

King Abdulaziz University Hospital

20-23 February 2006

(21-24 Muharram 1427)

The technique for nephron sparing surgery for renal cortical tumours with parachute suturing guided by intra operative ultrasound in cases where wedge resection and partial nephrectomy are not feasible

T. Tassadaq, O. Siddiki, H. Abu Taha

Urology Unit, Al-Qudah H, Saad Specialist Hospital, Khobar, Saudi Arabia

Objective: To devise a procedure for tumor excision in small incidentally diagnosed renal cortical tumors.

Patients and Methods: Three male patients aged 71, 48 and 60 years with tumor affecting one side of the renal cortex in the middle of the kidney underwent this procedure. Two patients had bilateral tumors. They all underwent CT/Angiogram to visualize the renal vascularity and metastatic screening preoperatively. The kidneys were completely mobilized. Vascular loops were placed around the renal arteries. Intraoperative ultrasound was performed and depth/extent of tumor was assessed. Mattress sutures encompassing the whole cortex were placed about 5 mm away from edged of the tumor with string left long. Tumor was excised using knife with 3 mm clear margin. Temporary haemostasis was achieved by pulling on the vascular loops and use of bulldog clamps as required. Large vascular bleeders were controlled with figure of eight stitches. Collecting system was inspected for any breach. Two patients required a double J stent which was inserted in an antegrade manner. Tyco seal (Tm Nycomed) was applied to the raw area. A ball of rolled surgical (Tm Johnson and Johnson) was placed in the defect and long ends of previously placed sutures were tied over in a parachute manner. The excised specimen was sent for frozen section analysis to confirm a complete excision. Formal histopathology revealed clear cell carcinoma in two patients and oncocytoma in the other.

Results: We were able to excise the tumors completely and secure adequate haemostasis in all patients. Follow up CT scans did not reveal any recurrence at the operative site.

Conclusion: Due to the routine use of abdominal ultrasound, the diagnosis of small, incidental renal tumors is increasing. Nephron sparing surgery is a recognized treatment modality for these cases. Renal lesions arising from the middle part of kidney involving only the anterior or posterior cortex are not amenable to either partial (polar) nephrectomy or a wedge resection (that included the convex margin). This technique is an addition to the armamentarium of urologist while dealing with these difficult cases.

Presented at the: 21 st Saudi Urological Conference

North West Armed Forces Hospital - Tabuk

14-16 April 2009

Giant renal angiomyolipoma: Is conservative management safe?

Mohamed A. Gomha, Ammar Al-Shaikh, Elsawi Medani, A. Poovathumkadavil

Department of Urology, King Fahd Specialist Hospital, Dammam, Saudi Arabia

Aim: Giant renal angiomyolipoma is associated with more risks of pain, hematuria and bleeding and presents a therapeutic challenge. We report 5 patients with big renal angiomyolipomas treated conservatively.

Materials and Methods: Five patients were diagnosed to have big angiomyolipoma that were treated conservatively. The medical records of these patients were reviewed as regards clinical findings, renal function, imaging characteristics, management and outcome.

Results: A total of 5 patients, 3 females and 2 males with median age of 40 years (range 23-66). Angiomyolipomas were bilateral and associated with tuberous sclerosis in 3 patients and unilateral in 2 (both on left side) accounting for 8 affected kidneys. The main presenting symptom was mild abdominal discomfort in 4 and abdominal bulge in 1. Giant angiomyolipomas (>10 cm) were seen in 7 kidneys with a size range 12 to 27.5 cm. This 27.5 cm angiomyolipoma extends from the diaphragm to the pelvis with some compression of the bladder. Big aneurysm was found in 2 big tumors that were prophylactically managed by superselective embolization. CT at last follow up showed disappearance of one aneurysm and the other one was markedly reduced in size. At last follow up with a median duration of 23 months (range 16-48), 2 patients had no symptoms and 3 had minimal discomfort and renal function remains normal with a median serum creatinine of 61 micromol/L (range 41-116).

Conclusion: Giant angiomyolipoma can be managed conservatively thus preserving renal function. However, longer follow is essential. Big aneurysms within angiomyolipoma can be successfully treated by superselective embolization.

Presented at the: 23 rd Saudi Urological Conference

King Fahd Specialist Hospital - Dammam

21-24 February 2011

Partial nephrectomy for tumors over 4 cm: Oncological, clinical outcomes and assessment of complication using a graded score

Ali Al-Zahrani, Juan P. Barroso, Ana M. Antran, Chen Lό, Andrew Williams, Curtis Chin, Hanuel Park, Patric Luke, Jonathan Izawa, Joseph Chin

Department of Urology, London Health Science Center, UWO, Ontario, Canada

Introduction: The role of nephron-sparing surgery (NSS) is well established for T1a renal lesions (<4 cm). Renal tumor control achieved by NSS is equivalent to the one achieved by Radical Nephrectomy (RN) in appropriately selected patients, offering the benefits of decreased renal insufficiency rate when compared to RN. Recent data for renal tumors >4 cms have suggested that it might be possible to expand the indication of NSS, with comparable oncological and clinical outcomes. However, NSS for tumors > 4 cms has been associated with a slightly higher rate of complications. The primary objective of this study is to evaluate the oncological and clinical outcomes of NSS for renal tumor >4 cms and to assess the complications based on a graded, validated and reproducible score (Clavien grade).

Materials and Methods: After the approval of the institutional ethics board, we retrospectively identified 214 patients who underwent NSS for renal tumors. Thirty nine patients had tumors over 4 cms. The study period was from 2002 to 2009. Patients with metastasis at the time of diagnosis, follow up of less than 6 months or with non sporadic tumors were excluded from the study. Continuous and categorical variables were assessed with Mann-Whitney U test and chi-square test, respectively. Kaplan-Meier analysis was used to calculate the overall survival and cancer specific survival rate. The assessment of the complication was done using the Clavien score.

Results: Forty five tumors were identified in 39 patients. The median age was 61 year ΁ 1.7. Median tumor size was 5.2 cms. The surgical indication was imperative in 7 patients (solitary kidney or contralateral atrophic kidney) and elective in 32 (82%). The final pathology report showed that 34 (81.2%) and 5 (18.2%) tumors were malignant and benign, respectively. After a mean follow up of 35.8 months (median 34 months), the over all survival rate was 89.7% while none had died from renal tumors. Tumor recurrence was detected in 2 patients (5.9%). There were 18 complications in 14 patients (35.9%) and most of these complications were grade 1-2 (61.1%).

Conclusion: NSS for tumors >4 cm is surgically feasible and has good oncological outcome. Assessment of the peri-operative complications with the Clavien grading system showed that most of these events are minor in severity (Grade 1-2).

Presented at the: 23 rd Saudi Urological Conference

King Fahd Specialist Hospital - Dammam

21-24 February 2011


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