Manejo del tumor renal de gran volumen: a propósito de un caso

Abstract

The incidence of bulky kidney tumors has decreased thanks to the widespread use of radiographic studies that enable early diagnosis and treatment. However, there are still cases of giant tumors that are true surgical challenges.

A 47-year-old woman presented with right hemi-abdominal pain 3 years prior, along with increased abdominal circumference, fever, and poor general status. Tomography scan revealed a right kidney tumor (30 × 19 × 15 cm) occupying 80% of the abdominal cavity. Radical nephrectomy was performed at the midline with blood loss of 1,800 cc. The patient progressed favorably and was released 48 h after the procedure. The histopathologic study reported a stage III chromophobe carcinoma (pT3a) that measured 31 × 19 × 13 cm and weighed 4,630 g There was successful oncologic control at 6 months.

Large-volume kidney tumors are advanced stage lesions associated with poor outcome. Preoperative embolization plays an important role in reducing intraoperative blood loss. If the tumor is considered resectable, the open approach is preferred over the laparoscopic one. Flank approaches (subcostal, supracostal, or transcostal), thoracoabdominal, lumbotomy, or anterior approaches (subcostal, Chevron, midline or paramedian) have been described. The best approach should match the anatomy of the patient and the characteristics of the tumor.

Bulky renal masses are a surgical challenge. Therapeutic success depends on adequate perioperative evaluation of the patient and the tumor, establishing the ideal approach.