Renal Tumor

Dr. Abdullah A. Ghazi (R4)23/4/2011

Half day resident activity

Case 1

• 70y old male, medially free.• c/o: vague abdominal pain.• u/s: Lt renal mass.

What is the Rule of Adrenalectomy in Renal Tumor?

Rule of Adrenalectomy in Renal TumorNot indicated in

• Pre-operative tumor staging (CT, MRI) shows a normal adrenal gland.

• Intra-operative findings do not give any indication of a nodule within the adrenal gland suspicious of metastatic disease.

• There is no evidence of direct invasion of the adrenal gland by a large upper pole tumor.

What is the Rule of LN Dissection?

Case 2

• 55y old female, DM, HTN.• C/o: Rt flank pain.

Case 3

• 50 y old F.• Asymtomatic.• Incidental found to have Lt renal mass.

Indications for nephron-sparing surgery

• Absolute – anatomical or functional solitary kidney;

• Relative – functioning opposite kidney is affected by a condition that might impair renal function in the future.

• Elective – localized unilateral RCC with a healthy contralateral kidney.

NSS not suitable for

• Locally advanced tumor growth.• Partial resection is not technically feasible

because the tumor is in an unfavorable location.

• Significant deterioration of a patient’s general health.

Effect of Positive Margin?

??concern

? Cytoreductive Nephrectomy

Post Operative Surveillance

• Post-operative complications.• Renal function.• Local recurrence after partial nephrectomy or

ablative treatment.• Recurrence in the contralateral kidney.• Development of metastases.

Bosniak Classification

THANKS