Ishikawa Keisuke, Nagata Masayoshi, Tomari Miki, Mito Osamu, Hirano Hisashi, Shimizu Fumitaka, Isotani Shuji, Ide Hisamitsu, Horie Shigeo
Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Case Rep Oncol. 2024 Nov 19;17(1):1316-1321. doi: 10.1159/000542059. eCollection 2024 Jan-Dec.
Although urological surgeons often diagnose cases of simultaneous double cancers of the urinary tract in our clinical practice, few reports have shown that treatment strategies achieve both anticancer effects and preservation of renal function for simultaneous contralateral renal cell carcinoma and urothelial carcinoma. Although there are many options for the treatment of renal cancer, such as immunotherapy and - drugs, and many surgical procedures, such as laparoscopic surgery and robot-assisted surgery, no treatment strategy has been established for double cancer of the bilateral urinary tracts. We encountered a case in which contralateral renal surgery was performed under a precise preoperative plan; as a result, the introduction of dialysis could be avoided, and the anticancer effect could be maintained.
A 73-year-old man was diagnosed with contralateral left renal cell carcinoma and right ureteral cancer. Initially, the patient underwent laparoscopic radical nephroureterectomy for right ureteral urothelial carcinoma. Subsequently, robot-assisted laparoscopic partial nephrectomy for left renal cell carcinoma was performed after treatment with the molecular-targeted agent, pazopanib. Even after partial nephrectomy, renal function was maintained, and dialysis was avoided.
In cases of simultaneous renal cell carcinoma and contralateral ureteral cancer, it is possible to preserve both anticancer effects and renal function using careful treatment strategies.
尽管泌尿外科医生在临床实践中经常诊断出同时发生的双侧泌尿系统双癌病例,但很少有报告表明治疗策略能同时实现抗癌效果并保留对侧肾细胞癌和尿路上皮癌患者的肾功能。虽然肾癌的治疗有多种选择,如免疫疗法和药物,以及许多手术方法,如腹腔镜手术和机器人辅助手术,但双侧泌尿系统双癌尚无既定的治疗策略。我们遇到了一例在精确的术前规划下进行对侧肾手术的病例;结果,避免了透析的介入,并维持了抗癌效果。
一名73岁男性被诊断为左侧对侧肾细胞癌和右侧输尿管癌。最初,患者接受了腹腔镜根治性肾输尿管切除术以治疗右侧输尿管尿路上皮癌。随后,在使用分子靶向药物帕唑帕尼治疗后,进行了机器人辅助腹腔镜部分肾切除术以治疗左侧肾细胞癌。即使在部分肾切除术后,肾功能仍得以维持,避免了透析。
在同时发生肾细胞癌和对侧输尿管癌的病例中,采用谨慎的治疗策略有可能同时保留抗癌效果和肾功能。