Ten-year -experience in the management of renal cell carcinoma: a retrospective study

ABSTRACT

The evolution of diagnostic tools and therapy protocols for renal cell carcinoma [RCC] during the last decades dictates regular evaluation of the results and achievements. Through this retrospective study, we aimed to review our results in the diagnosis and treatment of RCC during the last 10 years. The complete files of 53 patients treated for RCC during the last 10 years were reviewed. The clinical records, imaging studies, operative notes and post operative surveillance data were all analyzed. A total of 45 patients presented with symptoms related to the tumour while 8 were discovered incidentally. CT scans showed a sensitivity and specificity of 100% and 92% in diagnosing caval extension; and of 87.5% and 93.3% in diagnosing nodal involvement, respectively. MRI was more precise in evaluating thrombus extension to the vena cava. Radical nephrectomy was performed in 35 patients with one prioperative mortality and an overall complication rate of 28.6%. Meanwhile, 18 patients underwent nephron sparing surgery [NSS] half of whom were for imperative indications. Complication rate in this group mounted to 55.6%. However, most complications were smoothly manageable. After a mean follow up period of 26.4 months, 3 patients died of unknown causes, 2 died with pulmonary metastases and 1 with local recurrence. Furthrmore, 5 patients showed evidence of local recurrence and were all alive at the conclusion of the study. Regular ultrasonographic check ups are essential for earlier diagnosis of RCC. CT assessment of such tumours supported by MRA yielded excellent results in assessing caval extension but nodal assessment may be still fallacious. NSS when performed in small tumours, can yield very encouraging results. However, we still need to gain more experience in this field