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Robotic partial nephrectomy after pazopanib treatment in a solitary kidney with segmental vein thrombosis.
- 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&#95;Garisto&#95;et&#95;al.<br />Competing Interests: None declared.<br /> (Copyright® by the International Brazilian Journal of Urology.)
- Subjects :
- Aged
Carcinoma, Renal Cell drug therapy
Carcinoma, Renal Cell surgery
Humans
Indazoles
Kidney Neoplasms drug therapy
Kidney Neoplasms surgery
Male
Neoadjuvant Therapy
Operative Time
Treatment Outcome
Venous Thrombosis drug therapy
Nephrectomy methods
Pyrimidines therapeutic use
Receptors, Vascular Endothelial Growth Factor therapeutic use
Robotic Surgical Procedures methods
Solitary Kidney surgery
Sulfonamides therapeutic use
Venous Thrombosis surgery
Subjects
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