Enucleation of renal cell carcinoma with ablation of the tumour base

Abstract

OBJECTIVE To retrospectively assess the effectiveness of cancer control with enucleation of renal cell carcinoma (RCC), which is surgically expedient, allows preservation of maximal renal parenchyma, and makes intraoperative renal ischaemia unnecessary, by two surgeons routinely enucleating renal tumours and ablating the tumour bed with argon beam and the Nd‐YAG laser. PATIENTS AND METHODS Between 1996 and 2006 at our institution, 97 patients had RCC enucleated, with ablation of the tumour base. Patients with lesions other than RCC and those with von Hippel‐Lindau disease or Birt‐Hogg‐Dube syndrome were excluded from the study. The mean follow‐up was 24.9 months. Patients were evaluated for RCC recurrence with cross‐sectional imaging at least every 6 months for the first 2 years and then annually thereafter. RESULTS The mean (median, range) tumour size was 2.8 (2.5, 0.8–7.0) cm. Of the 97 patients only one had disease progression after a mean follow‐up of 24.9 months. This patient presented with a solitary grade 2 clear cell RCC and had a local recurrence 30 months after original surgery. CONCLUSIONS The present series and other available clinical data suggest that enucleation with cavity ablation is an oncologically sound approach that is simple, versatile and obviates the need for renal ischaemia.

Endoscopic robot-assisted simple enucleation (ERASE) for clinical T1 renal masses: description of the technique and early postoperative results

“…In this scenario, some studies have supported the oncological efficacy of the simple enucleation (SE) technique, defined as the blunt excision of the tumor without a visible margin, following the natural cleavage plane between the tumor capsule and healthy parenchyma. Prospective studies confirmed the SE safety from a pathological perspective [3] and large retrospective series showed its oncological equivalence to standard PN [4][5][6].Data from the largest comparative study between open PN (OPN) and laparoscopic PN (LPN) found LPN to be a Electronic supplementary material The online version of this article ( …”

Pathological characteristics and prognostic effect of peritumoral capsule penetration in renal cell carcinoma after tumor enucleation

“…Overall, many large series with single sporadic RCC treated conservatively by either standard partial nephrectomy or TE reported favorable survival and recurrence rates, but tumor progression may occur in some cases [2,[4][5][6][7][9][10][11][12]. This evidence has led to identifying clinical and pathological parameters as predictors of disease progression.…”

“…The recent European Association of Urology guidelines expanded its indication for solitary renal cell carcinoma (RCC) up to a diameter of 7 cm, whenever technically feasible. A minimal tumor-free surgical margin appears appropriate to avoid the risk of local recurrence, thus supporting the possible use of the tumor enucleation (TE), which is a nephron-sparing procedure with oncological effectiveness supported by numerous papers (Level of Evidence 2b) [1][2][3][4][5][6][7][8]. Over the past years, this technique has received a wider consensus as an alternative to standard partial nephrectomy for T1 RCC and has been adopted in several centers [8].…”

Tumour enucleation vs partial nephrectomy: Long term results

“…Several retrospective studies have confirmed good oncologic results of SE and some of these studies have demonstrated also a similar local recurrence-free survival and cancer specific survival rates between SE and standard PN, for renal tumors with clinical diameter up to 7 cm; one study have also confirmed similar cancer specific survival between SE and radical nephrectomy [18][19][20][21][22][23][24][25].…”