Abdomen, Kidney, Urinary Tract / Bladder, CT, MR, Diagnostic procedure, Surgery, Technical aspects, Cancer, Neoplasia
D. Garrido, S. Dutra, S. Amante, M. Chaves, M. Brum; Ponta Delgada/PT
Renal tumors are relatively common findings in daily clinical practice,
either incidentally discovered in cross sectional studies performed for other purposes or when investigating related signs and symptoms such as hematuria or flank pain.
Recent literature suggests a growing incidence which can,
at least in part,
be explained by technological advances and widespread availability of imaging studies.
Also noted is a tendency for increased detection of smaller tumors,
easy to understand in light of the same reasons stated above.
Renal cell carcinoma is the third most common cancer worldwide and generally carries a favorable prognosis if detected early and amenable to partial or complete resection/nephrectomy. However,
studies have shown increased risk of chronic kidney disease and associated cardiovascular complications on patients submitted to total nephrectomy when compared to healthy age matched controls likely due to vicarious filtration brought upon by the lower nephron count.
Kidney-sparing partial nephrectomy is thus a growing concern and an ever more common practice,
as urologists aim to prevent radical nephrectomy and preserve kidney function,
and while recent studies show an increase from around 27% to 40% of tumors treated with partial nephrectomies,
such a number is still considered suboptimal.
Difficulty remains in selecting which patients are amenable to safe tumorectomy / partial nephrectomy,
with many decisions on treatment plan currently being made on the basis of personal or institutional surgical expertise.
nephrometry score was developed and validated to provide standardized assessment of tumor features,
surgical risk and complexity as well as prognostic assessment to help answer these questions and guide the choice of surgical procedure.