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International Journal of Clinical and Experimental Medicine Research

“Nephron sparing surgery” in a tumor greater than 7 cm

Author:Isa Haxhiu1, Xhedet Çuni1, Emirjon Haxhiu1, Rexhep Kasumaj1, Rinor Haxhiu1, Salih Krasniqi2, Besnik Elshani3, Anduenë Haxhiu1 Date:January 30,2018 Hits:

Abstract

Introduction: We present a case of nephron sparing surgery (NSS), of a patient,68 years old, resident in e Prizren, who had a tumor bigger than 7 (8.5 cm), meaning T2a staging tumor. Renal cell carcinoma (RCC) is a common malignancy with an increasing incidence. NSS was proven feasible decades ago for patients with imperative indications to preserve maximum kidney function, for instance solitary kidney, bilateral renal tumors, or moderate/severe chronic kidney disease (ChKD).
Purpose: The goal of partial nephrectomy is complete excision of potentially malignant tissue without malignant cells at the border of the surgical specimen, with maximum preservation of nearby normal renal parenchyma. It is known that nephron sparing surgery is preferred for T1a and T1b, or when the tumor is limited in kidneys and not greater than 7 cm. In this case, the tumor has passed T1 staging, it belonged to T2 staging .We succeeded doing the “nephron sparing surgery”, saving less than half of the kidney.
Result: The approach to a SRM (small renal masses) is based on tumor size, stage, and location. Most NSS requires renal vessel occlusion during the excision, and renal tubular tissue is partic-ularly sensitive to ischemia; the WIT (warm ischemia time), therefore, should be minimized. Damage to renal tubular tissue is directly related to WIT. Although the upper limit of WIT is de-batable, a limit of 20 minutes is a generally accepted guideline. The kidney can be approached with traditional “open” surgery or laparoscopically. For SRMs appropriate for NSS, open partial nephrectomy represents the gold standard. This approach has the most data regarding oncologic and renal function outcomes, with long-term cancer-specific survival rates exceeding 90%.
Conclusion: We can conclude that “nephron sparing surgery” in specific cases can be used also for patients with T2a staging tumor, for those patients were there is hope that they can benefit from this procedure. The patient has stayed in our clinic for ten days, and is released in a good health condition, unfortunately the remaining renal parenchyma was not sufficient to perform its function, because of the chronic pyelonephritis with an emphasized hypoplasia of the other kidney (left kid-ney). So the only benefit of this procedure in this patient was that instead of doing the dialysis three times a week, he could do it two times a week.

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“Nephron sparing surgery” in a tumor greater than 7 cm 
Isa Haxhiu1, Xhedet Çuni1, Emirjon Haxhiu1, Rexhep Kasumaj1, Rinor Haxhiu1, Salih Krasniqi2, Besnik Elshani3, Anduenë Haxhiu1
1University Clinical Centre of Kosovo, Urologic Clinic
2University Clinical Centre of Kosovo, Abdiminal Surgery Clinic
3University Clinical Centre of Kosovo, Neurosurgery Clinic
Corresponding to: Isa Haxhiu, University Clinical Centre of Kosovo, Urologic Clinic
How to cite this paper: Haxhiu, I., et al. (2018) “Nephron sparing surgery” in a tumor greater than 7 cm. International Journal of Clinical and Experimental Medicine Research, 2(1), 22-28.
DOI: 10.26855/ijcemr.2018.01.001
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