Nagasawa Seiji, Fukuda Takahiro, Motoki Noritaka, Yamauchi Tomoaki, Tabata Asahi, Hayashi Takahiro, Taguchi Motohiro, Shimatani Kimihiro, Iio Hiroyuki, Yanagi Toueki, Yamada Yusuke, Go Shuken, Kanematsu Akihiro, Nojima Michio, Yamamoto Shingo, Yamasaki Takashi, Hirota Seiichi
The Department of Urology, Hyogo College of Medicine.
The Department of Pathology, Hyogo College of Medicine.
Hinyokika Kiyo. 2023 Aug;69(8):221-226. doi: 10.14989/ActaUrolJap_69_8_221.
CASE 1: A male in his 60s underwent a right transperitoneal laparoscopic partial nephrectomy procedure for a right renal tumor. Rupture of a renal cyst located close to the tumor occurred intraoperatively. The histopathological diagnosis was clear cell renal cell carcinoma (CCRCC), pT1aN0M0, G2, v0, with negative resection margins. At 84 months after surgery, computed tomography (CT) revealed a 10 mm mass in the rectus abdominis muscle at the camera port site used for the partial nephrectomy. An open lumpectomy was then performed and the histopathological diagnosis was CCRCC. One year later, a 40 mm sized mass was detected in the mesentery of the small intestine by CT, which was removed laparoscopically with part of the mesentery and diagnosed as CCRCC. Since that surgery, the patient has been free from recurrence for 8 years.
CASE 2: A male in his 60s underwent a left retroperitoneal laparoscopic nephrectomy procedure for a left renal tumor. The histopathological diagnosis was CCRCC, pT1aN0M0, G1, v0, with negative resection margins. At 31 months after surgery, CT revealed a 32 mm mass in the retroperitoneal cavity at the right hand port site used for the laparoscopic nephrectomy. The mass was removed with part of the twelfth rib and erector spinae muscles in a lump, and the histopathological diagnosis was CCRCC. Since that surgery, the patient has been free from recurrence for 19 months. For the treatment of solitary port site recurrence of renal cell carcinoma after a laparoscopic radical/partial nephrectomy, we recommend surgical resection for a good prognosis.
病例1:一名60多岁男性因右肾肿瘤接受了经腹腔右侧腹腔镜下部分肾切除术。术中靠近肿瘤的一个肾囊肿破裂。组织病理学诊断为透明细胞肾细胞癌(CCRCC),pT1aN0M0,G2,v0,切缘阴性。术后84个月,计算机断层扫描(CT)显示在部分肾切除术所用摄像端口部位的腹直肌中有一个10毫米的肿块。随后进行了开放性肿块切除术,组织病理学诊断为CCRCC。一年后,CT在小肠系膜中检测到一个40毫米大小的肿块,通过腹腔镜将其与部分系膜一并切除,诊断为CCRCC。自那次手术后,患者已无复发8年。
病例2:一名60多岁男性因左肾肿瘤接受了经后腹腔左侧腹腔镜肾切除术。组织病理学诊断为CCRCC,pT1aN0M0,G1,v0,切缘阴性。术后31个月,CT显示在腹腔镜肾切除术所用右手端口部位的后腹腔中有一个32毫米的肿块。该肿块与第十二肋及竖脊肌的一部分一并整块切除,组织病理学诊断为CCRCC。自那次手术后,患者已无复发19个月。对于腹腔镜根治性/部分肾切除术后肾细胞癌孤立性端口部位复发的治疗,我们建议手术切除以获得良好预后。