Zhang Yiman, Zhao Taoyue, Li Zhongyi, Jin Xiao, Wang Zhaohui, Shen Haixiang
Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, China.
Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, China.
Int J Surg Case Rep. 2025 Jun 11;133:111483. doi: 10.1016/j.ijscr.2025.111483.
The incidental discovery of renal tumors during pregnancy necessitates a tailored treatment that carefully balances the health and well-being of both the mother and the developing fetus.
The patient accidentally found a renal mass on abdominal ultrasound in the second trimester, and following MRI diagnosed cT1bN0M0 renal cancer. Following a multidisciplinary consultation and taking into account the patient's clinical status and preferences, retroperitoneoscopic robot-assisted laparoscopic partial nephrectomy (rRAPN) was successfully performed at 26 weeks of gestation. The procedure was completed without any postoperative complications and clear cell renal cell carcinoma was confirmed by histopathology. The postoperative recovery of the patient was uneventful and the baby was born safely at 38 weeks of gestation.
Gestational renal tumor is usually detected by routine antenatal ultrasonography incidentally without any typical symptoms, of which 50 % are malignant. The clinical decision-making process poses significant challenges, necessitating meticulous risk-benefit analysis to balance tumor control efficacy with perinatal safety. The two principal surgical approaches for renal tumor resection are the transperitoneal and retroperitoneoscopic routes, with selection guided by tumor location, surgeon expertise, and patient-specific anatomical considerations.
rRAPN is safe and effective in the second trimester. Personalized treatment should be made for each gestational RCC by a multidisciplinary team.
孕期偶然发现肾肿瘤需要采取量身定制的治疗方案，要仔细权衡母亲和发育中胎儿的健康与福祉。
患者在孕中期腹部超声检查时意外发现肾肿物，经磁共振成像（MRI）诊断为cT1bN0M0期肾癌。经过多学科会诊并考虑患者的临床状况和偏好后，于妊娠26周成功进行了后腹腔镜机器人辅助腹腔镜部分肾切除术（rRAPN）。手术完成后无任何术后并发症，组织病理学确诊为透明细胞肾细胞癌。患者术后恢复顺利，婴儿于妊娠38周安全出生。
妊娠期肾肿瘤通常在常规产前超声检查时偶然发现，无任何典型症状，其中50%为恶性。临床决策过程面临重大挑战，需要进行细致的风险效益分析，以平衡肿瘤控制效果与围产期安全性。肾肿瘤切除的两种主要手术途径是经腹腔和后腹腔镜途径，其选择取决于肿瘤位置、外科医生的专业技能以及患者特定的解剖学因素。
rRAPN在孕中期是安全有效的。多学科团队应为每例妊娠期肾细胞癌制定个性化治疗方案。
