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 Tumor Not 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

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