Ks. Hafez et al., Contemporary management of renal cell carcinoma with coexistent renal artery disease: Update of the Cleveland Clinic experience, UROLOGY, 56(3), 2000, pp. 382-386
Objectives. To treat concurrent renal cell carcinoma (RCC) and renal artery
disease (RAD), which pose an unusual and challenging management dilemma.
Methods. Before June 1998, 48 patients presented with localized RCC and RAD
affecting all the functioning renal parenchyma. These patients were groupe
d into four distinct categories: group 1, a solitary kidney with RCC and RA
D (n = 8); group 2, bilateral RCC and coexistent RAD (n = 9); group 3, unil
ateral RCC and contralateral RAD (n = 15); and group 4, unilateral RCC and
bilateral RAD (n = 16). The most common cause of RAD was atherosclerosis (n
= 40), followed by medial fibroplasia (n = 5), renal artery aneurysm (n =
2), and arteriovenous malformation (n = 1).
Results. All patients underwent complete surgical excision of RCC. A nephro
n-sparing operation was performed preferentially (44 patients), and bilater
al renal cancer operations were staged. Eleven patients underwent surgical
renal vascular reconstruction in conjunction with either partial (n = 9) or
radical (n = 2) nephrectomy. In 2 patients, renal revascularization was ac
complished by percutaneous transluminal angioplasty before tumor excision.
No perioperative deaths occurred. Postoperatively, preservation of renal fu
nction was achieved in 47 patients; 1 patient required chronic dialysis. Th
e overall and cancer-specific 5-year patient survival rates in this series
were 66% and 90%, respectively. At a mean follow-up of 58 months, 28 patien
ts were alive with no evidence of malignancy. Six patients died of metastat
ic RCC, and 14 died of unrelated causes with no evidence of malignancy.
Conclusions. Nephron-sparing surgery combined with selective renal arterial
reconstruction can yield gratifying results in this complex patient popula
tion. UROLOGY 56: 382-386, 2000. (C) 2000, Elsevier Science Inc.