Session

Medical, Chemical and Pharmaceutical Sciences

Description

We present a case of nephron sparing surgery (NSS), in a patient,68 years olld, born in the Prizren, who had a tumor bigger than 7 (8.5 cm), meaning T2a staging tumor.Renal cell carcinoma (RCC) is a common malignancy with an increasing incidence1. NSS was proven feasible decades ago for patients with imperative indications to preserve maximum kidney function, for instance solitary kidney, bilateral renal tumors, or moderate/severe chronic kidney disease (CKD)2. The goal of partial nephrectomy is complete excision of potentially malignant tissue without malignant cells at the border of the surgical specimen, with maximum preservation of nearby normal renal parenchyma.It is known that nephron sparing surgery is preferred for T1a and T1b, or when the tumor is limited in kidneys and not greater than 7 cm.In this case, the tumor has passed T1 staging, it belonged to T2 staging .We succeeded doing the “nephron sparing surgery”, saving less than half of the kidney.The approach to a SRM( small renal masses) is based on tumor size, stage, and location.Most NSS requires renal vessel occlusion during the excision, and renal tubular tissue is particularly sensitive to ischemia; the WIT ( warm ischemia time ), therefore, should be minimized. Damage to renal tubular tissue is directly related to WIT. Although the upper limit of WIT is debatable, a limit of 20 minutes is a generally accepted guideline.The kidney can be approached with traditional “open” surgery or laparoscopically. For SRMs appropriate for NSS, open partial nephrectomy represents the gold standard. This approach has the most data regarding oncologic and renal function outcomes, with long-term cancer-specific survival rates exceeding 90%3. We can conclude that “nephron sparing surgery” in specific cases can be used also for patients with T2a staging tumor, for those patients were there is hope that they can benefit from this procedure.The patient has stayed in our clinic for ten days, and is released in a good health condition,unfortunately the remaining renal parenchyma was not sufficient to perform its function, because of the chronic pyelonephritis with an emphasized hypoplasia of the other kidney ( left kidney). So the only benefit of this procedure in this patient was that instead of doing the dialysis three times a week, he could do it two times a week.

Keywords:

Nephron sparing surgery, renal carcinoma, partial nephrectomy, papillary renal cell carcinoma

Session Chair

Besnik Elshani

Session Co-Chair

Petrit Biberaj

Proceedings Editor

Edmond Hajrizi

ISBN

978-9951-437-67-7

First Page

27

Last Page

34

Location

Durres, Albania

Start Date

28-10-2017 2:00 PM

End Date

28-10-2017 3:30 PM

DOI

10.33107/ubt-ic.2017.287

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Oct 28th, 2:00 PM Oct 28th, 3:30 PM

“Nephron Sparing Surgery” in a Tumor Greater than 7 Cm

Durres, Albania

We present a case of nephron sparing surgery (NSS), in a patient,68 years olld, born in the Prizren, who had a tumor bigger than 7 (8.5 cm), meaning T2a staging tumor.Renal cell carcinoma (RCC) is a common malignancy with an increasing incidence1. NSS was proven feasible decades ago for patients with imperative indications to preserve maximum kidney function, for instance solitary kidney, bilateral renal tumors, or moderate/severe chronic kidney disease (CKD)2. The goal of partial nephrectomy is complete excision of potentially malignant tissue without malignant cells at the border of the surgical specimen, with maximum preservation of nearby normal renal parenchyma.It is known that nephron sparing surgery is preferred for T1a and T1b, or when the tumor is limited in kidneys and not greater than 7 cm.In this case, the tumor has passed T1 staging, it belonged to T2 staging .We succeeded doing the “nephron sparing surgery”, saving less than half of the kidney.The approach to a SRM( small renal masses) is based on tumor size, stage, and location.Most NSS requires renal vessel occlusion during the excision, and renal tubular tissue is particularly sensitive to ischemia; the WIT ( warm ischemia time ), therefore, should be minimized. Damage to renal tubular tissue is directly related to WIT. Although the upper limit of WIT is debatable, a limit of 20 minutes is a generally accepted guideline.The kidney can be approached with traditional “open” surgery or laparoscopically. For SRMs appropriate for NSS, open partial nephrectomy represents the gold standard. This approach has the most data regarding oncologic and renal function outcomes, with long-term cancer-specific survival rates exceeding 90%3. We can conclude that “nephron sparing surgery” in specific cases can be used also for patients with T2a staging tumor, for those patients were there is hope that they can benefit from this procedure.The patient has stayed in our clinic for ten days, and is released in a good health condition,unfortunately the remaining renal parenchyma was not sufficient to perform its function, because of the chronic pyelonephritis with an emphasized hypoplasia of the other kidney ( left kidney). So the only benefit of this procedure in this patient was that instead of doing the dialysis three times a week, he could do it two times a week.