Aggressive Surgical Approach to Renal Cell Carcinoma: Review of 130 Cases

No AccessJournal of Urology1 Sep 1979Aggressive Surgical Approach to Renal Cell Carcinoma: Review of 130 Cases W. Bedford Waters and Jerome P. Richie W. Bedford WatersW. Bedford Waters More articles by this author and Jerome P. RichieJerome P. Richie More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)56378-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail A retrospective analysis of 130 patients with renal cell carcinoma seen between 1957 and 1977 disclosed important diagnostic and pathologic factors relating to prognosis. Initial symptoms did not correlate with prognosis but a third of the patients had metastases when first seen by a physician. The classic triad of hematuria, flank pain and mass was present in only 4 per cent of the patients. Angiography demonstrated hypervascular tumors in 93 per cent of the patients. Hypovascularity on an angiogram correlated well with papillary renal cell carcinoma with improved prognosis. The renal vein was involved in 21 per cent of the patients and the inferior vena cava was involved in 4 per cent. Radical nephrectomy with or without lymph node dissection was the most common operation and heminephrectomy was performed in patients with a solitary kidney or hypoplastic contralateral kidney. Management of tumor thrombus in the renal vein or inferior vena cava required specialized operative techniques, including vena caval resection in 5 patients. Survival rates were calculated for each pathologic stage, with subgroups of renal vein or inferior vena caval involvement. Patients with stage I or II disease, with or without renal vein or vena caval involvement, had a much better prognosis than patients with stage III or IV disease. The addition of lymphadenectomy revealed many patients with unsuspected metastatic disease. Survival was increased when only a small number of lymph nodes were involved, suggesting some therapeutic as well as diagnostic gain from associated lymphadenectomy. Absolute lymphocyte counts of more than 2,000, as a reflection of immunologic status of the patient, did not correlate with survival rates. © 1979 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byO'Malley R, Godoy G, Kanofsky J and Taneja S (2018) The Necessity of Adrenalectomy at the Time of Radical Nephrectomy: A Systematic ReviewJournal of Urology, VOL. 181, NO. 5, (2009-2017), Online publication date: 1-May-2009.Okada Y, Kumada K, Terachi T, Nishimura K, Tomoyoshi T and Yoshida O (2018) Long-term Followup of Patients with Tumor Thrombi from Renal Cell Carcinoma and Total Replacement of the Inferior Vena Cava Using an Expanded Polytetrafluoroethylene Tubular GraftJournal of Urology, VOL. 155, NO. 2, (444-447), Online publication date: 1-Feb-1996.Sampaio C, Mclain D, Klein E and Bukowski R (2018) Renal Masses Simulating Primary Renal Cell Carcinoma in Patients with Advanced MalignanciesJournal of Urology, VOL. 151, NO. 6, (1505-1508), Online publication date: 1-Jun-1994.Giuliani L, Giberti C, Martorana G and Rovida S (2018) Radical Extensive Surgery for Renal Cell Carcinoma: Long-Term Results and Prognostic FactorsJournal of Urology, VOL. 143, NO. 3, (468-473), Online publication date: 1-Mar-1990.Gervasi L, Mata J, Easley J, Wilbanks J, Seale-Hawkins C, Carlton C and Scardino P (2018) Prognostic Significance of Lymph Nodal Metastases in Prostate CancerJournal of Urology, VOL. 142, NO. 2 Part 1, (332-336), Online publication date: 1-Aug-1989.Bassil B, Dosoretz D and Prout G (2018) Validation of the Tumor, Nodes and Metastasis Classification of Renal Cell CarcinomaJournal of Urology, VOL. 134, NO. 3, (450-454), Online publication date: 1-Sep-1985.Konnak J and Grossman H (2018) Renal Cell Carcinoma as an Incidental FindingJournal of Urology, VOL. 134, NO. 6, (1094-1096), Online publication date: 1-Dec-1985.Peterson N, Millikan J and Moore E (2018) Combined Renal and Vena Caval Trauma: A Review of Personal and Recorded ExperienceJournal of Urology, VOL. 133, NO. 4, (567-574), Online publication date: 1-Apr-1985.Otto U, Huland H, Baisch H and Klöppel G (2018) Transplantation of Human Renal Cell Carcinoma Into NMRI NU/NU Mice. 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Volume 122Issue 3September 1979Page: 306-308 Advertisement Copyright & Permissions© 1979 by The American Urological Association Education and Research, Inc.MetricsAuthor Information W. Bedford Waters More articles by this author Jerome P. Richie More articles by this author Expand All Advertisement PDF downloadLoading ...