MANAGEMENT OF SYNCHRONOUS RENAL-CELL CARCINOMA AND AORTIC DISEASE

BACKGROUND: We have noted a significant incidence of renal cell carcin oma (RCC) detected during evaluation for aneurysmal and aortoiliac occ lusive disease. The approach to synchronous malignancy and aortic dise ase (staged versus concurrent resection) is controversial, as is the m anagement of incidental RCC (partial versus radical nephrectomy). PATI ENTS AND METHODS: We reviewed our experience with incidental RCC in pa tients undergoing aortic reconstruction between 1991 and 1994. Ninety- seven patients underwent aortic reconstruction for aneurysmal (72), oc clusive (20), or embolic disease (5) during the time frame under revie w. All were men, Of the 80 preoperative computerized tomographic (CT) scans obtained, 7 (9%) demonstrated renal lesions suspicious for RCC. All lesions were explored and excised by partial or radical nephrectom y before heparinization and completion of the planned aortic procedure . RESULTS: The overall mortality rate was 3%. None of the deaths occur red in patients undergoing combined procedures. Four partial and three radical nephrectomies were performed. Of the 7 renal lesions, 2 were complex cysts and 5 were RCC. Both patients with complex cysts were tr eated with wedge resection. One patient required surgical drainage of a wound abscess after partial nephrectomy. No significant differences were found between preoperative (1.4 +/- 0.1 mg/dL) and postoperative (1.8 +/- 0.2 mg/dL) creatinine levels following combined procedures. O n follow-up CT scans done at 6-month intervals (mean follow-up 24 mont hs), no evidence exists of recurrence, metastasis, or graft infection. CONCLUSIONS: This patient population demonstrated an unexpectedly hig h prevalence of incidental RCC (5 of 80 CTs, 6%). No increase in morta lity was found when RCC and aortic disease were treated at the same op eration. While partial nephrectomy was associated with one wound infec tion in this series, it is an effective treatment for small incidental RCC and may avoid unnecessary nephrectomy in patients with benign dis ease. Based on the high incidence olf RCC in this population, we recom mend exploration of all suspicious lesions. Nephrectomy can be perform ed safely in the same setting as aortic reconstruction. Because underl ying renal dysfunction is not uncommon in patients with aneurysmal and aortoiliac occlusive disease, nephron-sparing surgery should be consi dered.