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Robotic partial nephrectomy after pazopanib treatment in a solitary kidney with segmental vein thrombosis.

Authors :
Garisto JD
Dagenais J
Sagalovich D
Bertolo R
Rini B
Kaouk J
Source :
International braz j urol : official journal of the Brazilian Society of Urology [Int Braz J Urol] 2019 Jul-Aug; Vol. 45 (4), pp. 859.
Publication Year :
2019

Abstract

Objective: To demonstrate our surgical technique of robotic partial nephrectomy (RPN) in a patient with a solitary kidney who received neoadjuvant Pazopanib, highlighting the multidisciplinary approach.<br />Materials and Methods: In our video, we present the case of 77-year-old male, Caucasian with 6.6cm left renal neoplasm in a solitary kidney. An initial percutaneous biopsy from the mass revealed clear cell RCC ISUP 2. After multidisciplinary tumor board meeting, Pazopanib (800mg once daily) was administered for 8 weeks with repeat imaging at completion of therapy. Post-TKI image study was compared with the pre-TKI CT using the Morphology, Attenuation, Size, and Structure criteria showing a favorable response to the treatment. Thereafter, a RPN was planned3. Perioperative surgical outcomes are presented.<br />Results: Operative time was 224 minutes with a cold ischemia time of 53 minutes. Estimated blood loss was 800ml and the length of hospital stay was 4 days. Pathology demonstrated a specimen of 7.6cm with a tumor size of 6.5cm consistent with clear cell renal carcinoma ISUP 3 with a TNM staging pT1b Nx. Postoperative GFR was maintained at 24 ml / min compared to the preoperative value of 33ml / min.<br />Conclusions: A multidisciplinary approach is effective for patients in whom nephron preservation is critical, providing na opportunity to select those that may benefi t from TKI therapy. Pazopanib may allow for PN in a highly selective subgroup of patients who would otherwise require radical nephrectomy. Prospective data will be necessary before this strategy can be disseminated into clinical practice. Available at: http://www.intbrazjurol.com.br/video-section/20180240_Garisto_et_al.<br />Competing Interests: None declared.<br /> (Copyright® by the International Brazilian Journal of Urology.)

Details

Language :
English
ISSN :
1677-6119
Volume :
45
Issue :
4
Database :
MEDLINE
Journal :
International braz j urol : official journal of the Brazilian Society of Urology
Publication Type :
Report
Accession number :
30901174
Full Text :
https://doi.org/10.1590/S1677-5538.IBJU.2018.0240