Nephrectomy or nephron-sparing surgery – how to decide?

Abstract

Aim of the studyRadical nephrectomy in the treatment of renal cell carcinoma (RCC) remains the gold standard, but nephron-sparing surgery (NSS) is still increasing in importance. The main goal of this study was to compare the diagnostic accuracy of ultrasound and multi-detector computed tomography in RCC staging and its influence on deciding about further patient treatment.Material and methods87 patients (age range 27–90 years; median 61.5) underwent ultrasound (US) scan and contrast-enhanced computed tomography (CE-CT) of the abdomen and pelvis. 28 patients were qualified for NSS. The remaining group of patients underwent nephrectomy.ResultsNSS was performed more frequently among patients with lesions in the lower pole of the kidney and there was no infiltration to the calyx and renal pelvis. Radical nephrectomy (RN) was pursued in cases with lesions in the central or upper pole. Lesion diameter in patients qualified for NSS was smaller than in patients qualified for radical nephrectomy.ConclusionsDetermining the relationship between tumour and adjacent structures is not a simple matter. According to our study, 50% of CT results differ from histopathology assessment. Tumour diameter determined in CT examination is larger than in ultrasound and histopathological measurements while US scanning tends to underestimate tumour size in relation to histopathological assessment.

Results of surgical management of renal cell carcinoma metastatic to the pancreas

“…The large number of patients with the occurrence of symptoms, the advancement of tumours in our patients, metastases to lymph nodes, and one positive margin are probably connected with their short survival period. Early detection of primary RCC, effective surgical procedure (nephrectomy or nephron-sparing surgery), long and thorough patient care, radical, and pancreatic parenchyma saving resections give patients in this group a chance for a prolonged life [ 17 , 20 ]. Pancreatic resections can nowadays be performed with low morbidity and mortality rates, in particular in high-volume centres [ 12 ].…”

Comparison of Radiation Dose From Conventional and Triple-bolus Computed Tomography Urography Protocols in the Diagnosis and Management of Patients With Renal Cortical Neoplasms

“…The diagnosis and treatment of renal cortical neoplasms (RCN) often involves CT imaging; indeed, CT is considered the standard imaging modality for these evaluations 7 .…”