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异位肾患嫌色细胞肾细胞癌行部分肾切除术后不可预测的复发:病例报告及文献复习

Unpredictable recurrence following partial nephrectomy for chromophobe renal cell carcinoma on an ectopic kidney: Case report and review of literature.

作者信息

El Aboudi Adam, Lakssir Jihad, Boualaoui Imad, Ibrahimi Ahmed, El-Sayegh Hachem, Nouini Yassine

机构信息

Department of Urology A, Ibn Sina Hospital, University of Rabat, Morocco.

出版信息

Int J Surg Case Rep. 2024 Sep;122:110118. doi: 10.1016/j.ijscr.2024.110118. Epub 2024 Aug 3.

Abstract

INTRODUCTION

Renal cell carcinoma is one of the 10 most common malignancies. Partial nephrectomy (PN) is the preferred treatment for localized ones. The incidence of local recurrence (LR) after a PN varies between zero and 17% in the literature. Managing a LR following PN is a challenging situation, both ablation therapy and salvage surgery are viable options.

CASE PRESENTATION

A 38-year-old woman with a history of a right open partial nephrectomy performed on an ectopic kidney four years ago, presented a loco regional recurrence, involving the right ovary and rectus muscle, which we managed by a radical nephrectomy with bilateral oophorectomy et resection of the rectus muscle nodules.

CLINICAL DISCUSSION

LR of RCC after PN presents a clinically challenging scenario. Treatment options include ablative therapy or surgical salvage therapy, which can be either by radical nephrectomy or by repeat partial nephrectomy. Ablative therapy has less complication rate and is preferred for small LR or on a solitary kidney. Repeat PN is also an option for preserving renal function but with high risk of complication. RN is an option if PN is technically challenging, especially in patients with a functional contralateral kidney.

CONCLUSION

Recurrent renal cell carcinoma (RCC) can manifest differently based on the primary treatment, as well as tumor and patient characteristics. Managing a LR following PN is a challenging situation, both ablation therapy and salvage surgery are viable options.

摘要

引言

肾细胞癌是十大常见恶性肿瘤之一。部分肾切除术(PN)是局限性肾细胞癌的首选治疗方法。文献中报道PN术后局部复发(LR)的发生率在0%至17%之间。处理PN术后的LR是一种具有挑战性的情况,消融治疗和挽救性手术都是可行的选择。

病例介绍

一名38岁女性,四年前因异位肾接受了右侧开放性部分肾切除术,现出现局部区域复发,累及右侧卵巢和腹直肌,我们通过根治性肾切除术、双侧卵巢切除术及腹直肌结节切除术进行治疗。

临床讨论

PN术后肾细胞癌的LR是一种具有临床挑战性的情况。治疗选择包括消融治疗或手术挽救治疗,后者可以是根治性肾切除术或再次部分肾切除术。消融治疗的并发症发生率较低,对于小的LR或单肾患者更为适用。再次PN也是保留肾功能的一种选择,但并发症风险较高。如果PN在技术上具有挑战性,尤其是对于对侧肾功能正常的患者,根治性肾切除术是一种选择。

结论

复发性肾细胞癌(RCC)根据初始治疗、肿瘤及患者特征的不同可表现各异。处理PN术后的LR是一种具有挑战性的情况,消融治疗和挽救性手术都是可行的选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea35/11367142/9841e12e1bb3/gr1.jpg

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