CASE PRESENTATION: A 64-year-old Indian male with a past history of coronary artery bypass graft surgery, congestive heart failure, and diabetes mellitus complained of worsening shortness of breath for 2 weeks. Incidentally, a transthoracic echocardiography showed a "thumb-like" mass in his right atrium extending into his right ventricle through the tricuspid valve with each systole. Abdomen magnetic resonance imaging revealed a heterogenous lobulated mass in the upper and mid-pole of his right kidney with a tumor extending into his inferior vena cava and right atrium, consistent with our diagnosis of advanced renal cell carcinoma which was later confirmed by surgical excision and histology. Radical right nephrectomy, lymph nodes clearance, inferior vena cava cavatomy, and complete tumor thrombectomy were performed successfully. Perioperatively, he did not require cardiopulmonary bypass or deep hypothermic circulatory arrest. He had no recurrence during the follow-up period for more than 2 years after surgery.
CONCLUSIONS: Advanced extension of renal cell carcinoma can occur with no apparent symptoms and be detected incidentally. In rare circumstances, atypical presentation of renal cell carcinoma should be considered in a patient presenting with right atrial mass detected by echocardiography. Renal cell carcinoma with inferior vena cava and right atrium extension is a complex surgical challenge, but excellent results can be obtained with proper patient selection, meticulous surgical techniques, and close perioperative patient care.
Report: A 58 year old man developed an AVM mimicking a vascular tumour within his left brachioradialis muscle 10 years after a nephrectomy for RCC. Ultrasound and magnetic resonance imaging did not reveal any suspicious features of the vascular lesion.The lesion was successfully removed surgically, and was later proven histopathologically to be metastatic RCC. Further imaging showed widespread metastatic disease, and the patient survived only 15 months after receiving tyrosine kinase inhibitor therapy.
Discussion: This case report aims to highlight a few important points: RCC metastases may be hypervascular, mimicking an AVM. A long disease free interval does not necessarily exclude recurrence or metastasis, as in this case, therefore long term surveillance is recommended. A high index of suspicion must be maintained to avoid delay in treatment, and biopsy of any suspicious lesion for histological examination is mandatory, albeit after many years of cancer remission. Whole body imaging with computed tomography or positron emission tomography computed tomography may detect clinically occult recurrence or metastases, and is important to guide further treatment.
METHOD: The protocol of this review is registered on PROSPERO(CRD42020190882). A comprehensive literature search was performed on Medline, Embase and Cochrane CENTRAL using MeSH terms and keywords for randomised controlled trials and observational studies on the topic. Risks of biases were assessed using the Cochrane RoB tool and the Newcastle-Ottawa Scale. For localised RCC, immediate surgery [including partial nephrectomy (PN) and radical nephrectomy (RN)] and delayed surgery [including active surveillance (AS) and delayed intervention (DI)] were compared. For metastatic RCC, upfront versus deferred cytoreductive nephrectomy (CN) were compared.
RESULTS: Eleven studies were included for quantitative analysis. Delayed surgery was significantly associated with worse cancer-specific survival (HR 1.67, 95% CI 1.23-2.27, p
OBJECTIVE: To examine the feasibility of TV-NOSE in live donor nephrectomy.
MATERIALS AND METHODS: 53 patients received LDN surgery at our hospital from September 2017 to December 2021. Retrospectively, living donor nephrectomy with TV-NOSE was compared to three different surgical procedures with standard specimen extraction.
RESULTS: 53 donor patients were included: 15 open (OLDN), 12 retroperitoneoscopic living donor nephrectomy (RPLDN), 10 transperitoneal living donor nephrectomy (TPLDN), and 16 standard laparoscopic living donor nephrectomy with transvaginal extraction (SLLDN TV-NOSE). SLLDN TVNOSE's longer operating time (p<0.0041) did not affect graft function. SLLDN TV-NOSE and RPLDN had shorter lengths of stay and better VAS trends than open LDN and TPLDN (p<0.05). SLLDN TV-NOSE donors reported acceptable surgical outcomes and unchanged sexual function. All patients had similar discharge creatinine levels, with 1-year transplant survival of 98% and just 1 graft loss in the TPLDN group.
CONCLUSION: SLLDN TV-NOSE is equivalent to RPLDN and better than open LDN and TPLDN in terms of duration of stay, VAS score, surgical outcomes, and sexual function. TVNOSE is a safe surgical procedure with an acceptable donor complication. TV-NOSE may be safely conducted in both developed and developing countries with proper patient selection.