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Renal Cell Carcinoma Surgical Treatment: DR Bilal Ahmad Resident Surgeon Urology BBH Rawalpindi
Renal Cell Carcinoma Surgical Treatment: DR Bilal Ahmad Resident Surgeon Urology BBH Rawalpindi
SURGICAL TREATMENT
BY
DR BILAL AHMAD
RESIDENT SURGEON
UROLOGY BBH RAWALPINDI
RENAL CELL CARCINOMA
Adenocarcinoma.
Arises from proximal convoluted tubules.
Majority of VHL gene deletions occur in distal
convoluted tubule.
85% of renal malignancies… sporadic and
hereditary.
CAUSES
Conventional (80%)
Papillary (10-15%)
Chromophobe (5%)
Medullary cell: rare
Sarcomatoid : infiltrative poorly differentiated
variant of any type in 5 to 25%, coagulative necrosis
in 30%.
DIAGNOSTIC EVALUATION
Classified into:
ANATOMICAL FACTORS: tumor size , venous, capsular and adrenal
involvement, lymph nodes and distant metastases.
Surveillance
Elderly and comorbid patients with incidental small
renal masses have a low RCC-specific mortality.
In selected patients with advanced age and/or
comorbidities, active surveillance (AS) is appropriate to
initially monitor small renal masses, followed, if
required, by treatment for progression.
The concept of AS differs from the concept of watchful
waiting.
Watchful waiting is reserved for patients whose
comorbidities contraindicate any subsequent active
treatment and who do not require follow-up imaging,
unless clinically indicated.
RADICAL NEPHRECTOMY
After this heart and great vessels are exposed and right atrial
venous and ascending aortic cannula placed.
Cardioplegia done.