부산대학교 도서관

Background: While partial nephrectomy is the recommended treatment for many small renal masses (4-7cm), anatomically complex tumors necessitate a clear understanding of the potential risks and benefits of partial nephrectomy, that's why tumor location assessment is essential to plan nephron sparing surgery or radical nephrectomy. Complete removal of the primary tumor remains the most relevant outcome of the surgical therapies and from a technical point of view partial nephrectomy is a more complex procedure than radical nephrectomy and has a higher risk of complications. Three-dimensional, volume rendered computerized tomography allows better operative planning with maximal preservation of unaffected parenchyma in the remnant kidney or radical nephrectomy. Objective: To compare the effectiveness of radical nephrectomy versus a Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) Classification of Renal Tumors in Patients who are candidates for Nephron Sparing Surgery. Material and method: We present a case of 35 years old patient that we admitted in our Clinic complaining of right lumbar pain and hematuria. On admission blood tests are normal and we perform a CT scan that describes a tumoUr located at the inferior pole of the right kidney, with some necrosis areas included, with a diameter of 49/55/55 mm, without invasion of the right kidney artery and vein, and a left atrophic kidney but with good renal function. We have a preoperative urological indication for Nephron Sparing Surgery for the right kidney, due to the CT scan description and the existence of a left atrophic kidney. The second day the patient has surgery and we decide to perform a radical nephrectomy because of the intraoperative surprise, with a tumor size of 10 cm which encompasses the entire kidney and not of almost 5,5 cm diameter described by the CT, and the presence of two lymph nodes of almost 0,5 cm around the right kidney artery and vein, and one behind the inferior cava vein. Results: After surgery patient's evolution was uneventful, without any increase of the Creatinine and Urea level, and maintaining an urine output of 1700 ml per day and we decide to discharge the patient on the 10th day post surgery. Conclusions: Although Nephron Sparing Surgery is increasingly being used with an excellent technical success rate, there are cases with complex renal masses that require Radical Nephrectomy and in our case the surgeon's decision for radical nephrectomy was the right one if we consider the postoperative histological examination which was of Bifocal Right Renal Carcinoma with Clear Cell pT1bN0. [ABSTRACT FROM AUTHOR]