Type:
Educational Exhibit
Keywords:
Kidney, Urinary Tract / Bladder, Interventional vascular, CT, CT-Angiography, Catheter arteriography, Embolisation, Diagnostic procedure, Surgery, Pathology
Authors:
A. Serdio1, M. Gredilla2, M. LETURIA ETXEBERRIA3, A. Aguado4, K. Biurrun Mancisidor2, G. Vega-Hazas Porrúa5; 1Donostia - San Sebastián/ES, 2DONOSTIA/ES, 3San Sebastian, Gipuzkoa/ES, 4San sebastian/ES, 5San SebastiáN/ES
DOI:
10.26044/ecr2019/C-2728
Background
For patients with localized renal cell carcinoma (RCC) and select patients with advanced RCC,
surgery can be curative.
Renal cell carcinoma (RCC):
- Responsible for 80 to 85 percent of all primary renal neoplasms.
- In Europe in 2012,
there were 115,000 cases and 49,000 deaths.
- Most are incidental findings due to the increasing development and availability of imaging techniques.
|
For patients undergoing definitive surgical treatment for RCC,
a radical nephrectomy (RN) or partial nephrectomy (PN) may be performed.
PN,
also known as nephron-sparing surgery,
has been established as the standard treatment for selected renal masses as it preserves renal function.
Indications of PN:
- Patients with a tumor ≤ 4 cm.
- Especially in patients with any of the following: 1) A solitary kidney,
2) Multiple,
small,
and/or bilateral tumors and 3) Patients with or at risk for chronic renal disease.
|
PN can be performed with an open,
laparoscopic or robotic-assisted approach,
based on the surgeon’s experience.
Despite the potential advantages of PN,
it remains a challenging operation with possible serious vascular complications owing to the difficulty recognizing the vascular border and abundant renal vascularity.
The possible complications include: vascular complications (perirrenal hemorrhage,
pseudoaneurisym,
arterial-venous fistula and active bleeding),
collecting system complications (urinary leakage or urinoma,
ureteral injury),
recurrent tumoral,
infection,
transient renal insufficiency and non-urological complications.
In our experience,
multidetector CT (MDCT) imaging allows detection of all kind of complications.
MDCT acquisition protocol includes 1) unenhanced,
2) corticomedullary,
3) nephrographic and 4) excretory phases.