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Published in: World Journal of Urology 2/2009

01-04-2009 | Original Article

Collecting system involvement by renal tumor: are CT measurements reliable enough?

Authors: Dmitry Goldin, Ron Molner, Jacob Shindler, Yoel Mecz, Yanina Sova, Natan Peled, Avi Stein

Published in: World Journal of Urology | Issue 2/2009

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Abstract

Objectives

Smaller kidney lesions which are more often detected recently by accidental imaging are amenable for nephron sparing approach whether at open surgery, laparoscopy or ablative techniques. The pretreatment planning is based on multiplanner CT expected to well define the relationship of the lesion to the major renal blood vessels and collecting system (CS). This study is aimed to compare the pre-surgical CT measurements of the distance from tumor to CS to the actual distances observed on radical nephrectomy specimens.

Patients and methods

Contrast CT of 39 patients with renal cell carcinoma (RCC) underwent measurements of the distance between CS and renal tumor. All measurements were confronted with the measurements performed on radical nephrectomy specimens of the same patients.

Results

Of all 39 patients in 34 (87%) CT showed a contact relation between the tumor and the CS. In fact, the CS involvement has been histologically proven only in three (7.6%) cases. Cutting off the measurements at thresholds of 2 and 5 mm also showed a significant discrepancy between CT and specimen measurements.

Conclusions

The trend of NSS and ablative techniques stressed out the importance of pretreatment measurements of the distance between the tumor and the CS. This study as performed on radical nephrectomy specimens points out the overestimated proximity of the tumor to the CS. These data if confirmed by other studies, may play a role while planning the management of NS approaches.
Literature
1.
go back to reference Novick AC, Derweesh IH (2005) Open partial nephrectomy for renal tumors: current status. BJU Int Suppl 2:35–40CrossRef Novick AC, Derweesh IH (2005) Open partial nephrectomy for renal tumors: current status. BJU Int Suppl 2:35–40CrossRef
2.
go back to reference Ficarra V (2007) Open radical nephrectomy versus open partial nephrectomy: is it still an issue? Eur Urol 51:593–595PubMedCrossRef Ficarra V (2007) Open radical nephrectomy versus open partial nephrectomy: is it still an issue? Eur Urol 51:593–595PubMedCrossRef
3.
go back to reference Aron M, Gill IS (2007) Minimally invasive nephron-sparing surgery (MINSS) for renal tumours. Part II: probe ablative therapy. Eur Urol 51(2):348–357PubMedCrossRef Aron M, Gill IS (2007) Minimally invasive nephron-sparing surgery (MINSS) for renal tumours. Part II: probe ablative therapy. Eur Urol 51(2):348–357PubMedCrossRef
4.
go back to reference Atwell TD, Farrell MA, Callstrom MR, Charboneau JW, Leibovich BC, Frank I, Patterson DE (2007) Percutaneous cryoablation of large renal masses: technical feasibility and short-term outcome. Am J Roentgenol 188(5):1195–1200CrossRef Atwell TD, Farrell MA, Callstrom MR, Charboneau JW, Leibovich BC, Frank I, Patterson DE (2007) Percutaneous cryoablation of large renal masses: technical feasibility and short-term outcome. Am J Roentgenol 188(5):1195–1200CrossRef
5.
go back to reference Patard JJ, Shvarts O, Lam JS, Pantuck AJ, Kim HL, Ficarra V, Cindolo L, Han KR, De La Taille A, Tostain J, Artibani W, Abbou CC, Lobel B, Chopin DK, Figlin RA, Mulders PFA, Belldegrun AS (2004) Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol 171:2181–2185PubMedCrossRef Patard JJ, Shvarts O, Lam JS, Pantuck AJ, Kim HL, Ficarra V, Cindolo L, Han KR, De La Taille A, Tostain J, Artibani W, Abbou CC, Lobel B, Chopin DK, Figlin RA, Mulders PFA, Belldegrun AS (2004) Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol 171:2181–2185PubMedCrossRef
6.
go back to reference Matin SF, Gill IS, Worley S, Novick AC (2002) Outcome of laparoscopic radical and open partial nephrectomy for the sporadic 4 cm. or less renal tumor with a normal contralateral kidney. J Urol 168:1356–1359PubMedCrossRef Matin SF, Gill IS, Worley S, Novick AC (2002) Outcome of laparoscopic radical and open partial nephrectomy for the sporadic 4 cm. or less renal tumor with a normal contralateral kidney. J Urol 168:1356–1359PubMedCrossRef
7.
go back to reference Fergany AF, Saad IR, Woo L, Novick AC (2006) Open partial nephrectomy for tumor in a solitary kidney: experience with 400 cases. J Urol 175(5):1630–1633PubMedCrossRef Fergany AF, Saad IR, Woo L, Novick AC (2006) Open partial nephrectomy for tumor in a solitary kidney: experience with 400 cases. J Urol 175(5):1630–1633PubMedCrossRef
8.
go back to reference Ramani AP, Desai MM, Steinberg AP, Ng CS, Abreu SC, Kaouk JH, Finelli A, Novick AC, Gill IS (2005) Complications of laparoscopic partial nephrectomy in 200 cases. J Urol 173(1):42–47PubMed Ramani AP, Desai MM, Steinberg AP, Ng CS, Abreu SC, Kaouk JH, Finelli A, Novick AC, Gill IS (2005) Complications of laparoscopic partial nephrectomy in 200 cases. J Urol 173(1):42–47PubMed
9.
go back to reference Zorn KC, Gong EM, Orvieto MA, Gofrit ON, Mikhail AA, Shalhav AL (2007) Impact of collecting-system repair during laparoscopic partial nephrectomy. J Endourol 21:315–320PubMedCrossRef Zorn KC, Gong EM, Orvieto MA, Gofrit ON, Mikhail AA, Shalhav AL (2007) Impact of collecting-system repair during laparoscopic partial nephrectomy. J Endourol 21:315–320PubMedCrossRef
10.
go back to reference Li QL, Guan HW, Zhang QP, Zhang LZ, Wang FP, Liu YJ (2003) Optimal margin in nephron-sparing surgery for renal cell carcinoma 4 cm or less. Eur Urol 44:448–451PubMedCrossRef Li QL, Guan HW, Zhang QP, Zhang LZ, Wang FP, Liu YJ (2003) Optimal margin in nephron-sparing surgery for renal cell carcinoma 4 cm or less. Eur Urol 44:448–451PubMedCrossRef
11.
go back to reference Carini M, Minervini A, Lapini A, Masieri L, Serni S (2006) Simple enucleation for the treatment of renal cell carcinoma between 4 and 7 cm in greatest dimension: progression and long-term survival. J Urol 175:2022–2026PubMedCrossRef Carini M, Minervini A, Lapini A, Masieri L, Serni S (2006) Simple enucleation for the treatment of renal cell carcinoma between 4 and 7 cm in greatest dimension: progression and long-term survival. J Urol 175:2022–2026PubMedCrossRef
12.
go back to reference Puppo P, Introini C, Calvi P, Naselli A (2004) Long term results of excision of small renal cancer surrounded by a minimal layer of grossly normal parenchyma: review of 94 cases. Eur Urol 46:477–481PubMedCrossRef Puppo P, Introini C, Calvi P, Naselli A (2004) Long term results of excision of small renal cancer surrounded by a minimal layer of grossly normal parenchyma: review of 94 cases. Eur Urol 46:477–481PubMedCrossRef
13.
go back to reference Derweesh IH, Herts BR, Motta-Ramirez GA, Ismail HR, Obuchowski N, Venerio J, Remer EM, Gill IS, Novick AC (2006) The predictive value of helical computed tomography for collecting-system entry during nephron-sparing surgery. BJU Int 98(5):963–968PubMedCrossRef Derweesh IH, Herts BR, Motta-Ramirez GA, Ismail HR, Obuchowski N, Venerio J, Remer EM, Gill IS, Novick AC (2006) The predictive value of helical computed tomography for collecting-system entry during nephron-sparing surgery. BJU Int 98(5):963–968PubMedCrossRef
14.
go back to reference Farrow G, Amin MB (1999) Protocol for the examination of specimens from patients with carcinomas of renal tubular origin, exclusive of Wilms tumor and tumors of urothelial origin: a basis for checklists. Cancer Committee, College of American Pathologists. Arch Pathol Lab Med 123:23–27PubMed Farrow G, Amin MB (1999) Protocol for the examination of specimens from patients with carcinomas of renal tubular origin, exclusive of Wilms tumor and tumors of urothelial origin: a basis for checklists. Cancer Committee, College of American Pathologists. Arch Pathol Lab Med 123:23–27PubMed
15.
go back to reference Lam JS, Shvarts O, Pantuck AJ (2004) Changing concepts in the surgical management of renal cell carcinoma. Eur Urol 45:692–705PubMedCrossRef Lam JS, Shvarts O, Pantuck AJ (2004) Changing concepts in the surgical management of renal cell carcinoma. Eur Urol 45:692–705PubMedCrossRef
16.
go back to reference Frank I, Colombo JR Jr, Rubinstein M, Desai M, Kaouk J, Gill IS (2006) Laparoscopic partial nephrectomy for centrally located renal tumors. J Urol 175:849–852PubMedCrossRef Frank I, Colombo JR Jr, Rubinstein M, Desai M, Kaouk J, Gill IS (2006) Laparoscopic partial nephrectomy for centrally located renal tumors. J Urol 175:849–852PubMedCrossRef
17.
go back to reference Uzzo RG, Novick AC (2001) Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 166(1):6–18PubMedCrossRef Uzzo RG, Novick AC (2001) Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 166(1):6–18PubMedCrossRef
18.
go back to reference Breda A, Stepanian SV, Lam JS, Liao JC, Gill IS, Colombo JR, Guazzoni G, Stifelman MD, Perry KT, Celia A, Breda G, Fornara P, Jackman SV, Rosales A, Palo J, Grasso M, Pansadoro V, Disanto V, Porpiglia F, Milani C, Abbou CC, Gaston R, Janetschek G, Soomro NA, De la Rosette JJ, Laguna PM, Schulam PG (2007) Use of haemostatic agents and glues during laparoscopic partial nephrectomy: a multi-institutional survey from the United States and Europe of 1347 cases. Eur Urol 52:798–803PubMedCrossRef Breda A, Stepanian SV, Lam JS, Liao JC, Gill IS, Colombo JR, Guazzoni G, Stifelman MD, Perry KT, Celia A, Breda G, Fornara P, Jackman SV, Rosales A, Palo J, Grasso M, Pansadoro V, Disanto V, Porpiglia F, Milani C, Abbou CC, Gaston R, Janetschek G, Soomro NA, De la Rosette JJ, Laguna PM, Schulam PG (2007) Use of haemostatic agents and glues during laparoscopic partial nephrectomy: a multi-institutional survey from the United States and Europe of 1347 cases. Eur Urol 52:798–803PubMedCrossRef
19.
go back to reference Hidas G, Kastin A, Mullerad M, Shental J, Moskovitz B, Nativ O (2006) Sutureless nephron-sparing surgery: use of albumin glutaraldehyde tissue adhesive (BioGlue). Urology 67:697–700PubMedCrossRef Hidas G, Kastin A, Mullerad M, Shental J, Moskovitz B, Nativ O (2006) Sutureless nephron-sparing surgery: use of albumin glutaraldehyde tissue adhesive (BioGlue). Urology 67:697–700PubMedCrossRef
20.
go back to reference Campbell SC, Novick AC, Streem SB, Klein E, Licht M (1994) Complications of nephron sparing surgery for renal tumors. J Urol 151:1177–1180PubMed Campbell SC, Novick AC, Streem SB, Klein E, Licht M (1994) Complications of nephron sparing surgery for renal tumors. J Urol 151:1177–1180PubMed
21.
go back to reference Gill IS, Matin SF, Desai MM, Kaouk JH, Steinberg A, Mascha E, Thornton J, Sherief MH, Strzempkowski B, Novick AC (2003) Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol 170:64–68PubMedCrossRef Gill IS, Matin SF, Desai MM, Kaouk JH, Steinberg A, Mascha E, Thornton J, Sherief MH, Strzempkowski B, Novick AC (2003) Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol 170:64–68PubMedCrossRef
22.
go back to reference Klatte T, Chung J, Leppert JT, Lam JS, Pantuck AJ, Figlin RA, Belldegrun AS (2007) Prognostic relevance of capsular involvement and collecting system invasion in stage I and II renal cell carcinoma. BJU Int 99(4):821–824PubMedCrossRef Klatte T, Chung J, Leppert JT, Lam JS, Pantuck AJ, Figlin RA, Belldegrun AS (2007) Prognostic relevance of capsular involvement and collecting system invasion in stage I and II renal cell carcinoma. BJU Int 99(4):821–824PubMedCrossRef
Metadata
Title
Collecting system involvement by renal tumor: are CT measurements reliable enough?
Authors
Dmitry Goldin
Ron Molner
Jacob Shindler
Yoel Mecz
Yanina Sova
Natan Peled
Avi Stein
Publication date
01-04-2009
Publisher
Springer-Verlag
Published in
World Journal of Urology / Issue 2/2009
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-008-0336-2

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