Solitary liver metastasis of chromophobe renal cell carcinoma 17 years after nephrectomy. A case report and review of the literature.

The prognosis for renal metastatic carcinoma is poor: in fact only a small portion of patients have metastases surgically treatable for their number and sizes with often a multiorgan involvement. We present a case in whit a solitary liver metastasis was incidentaly detected 17 years after nephrectomy for renal clear cell carcinoma. during a staging computed tomography performed for colonic cancer. We discuss the main feature of this rare condition.

Synchronous right nephrectomy, left kindey tumorectomy, right lateral hepatic sectorectomy and inferior vena cava thrombectomy for metastastic clear cell renal carcinoma. Report of a case and review of the literature.

The prognosis of stage IV renal cell carcinoma is very poor, since non-operative modalities for advanced renal carcinoma have failed to yield effective results. In fact, there is no indication for radiotherapy and systemic chemotherapy is not effective. Surgery, when indicated, seems to be the only therapeutic option possible.. Hepatectomy for metastatic renal cell carcinoma is very rarely reported, because multiple organ metastases ordinarily coexist. We report a case of a 61-year-old woman with a bilateral renal clear cell carcinoma, two synchronous liver metastasisi synchronous hepatic metastasis that were treated simultaneously with radical right nephrectomy, left upper pole kidney tumorectomy and right lateral liver sectorectomy. To the best of our knowledge this is the first case of a double liver metastasis and double renal carcinomas treated simultaneously. We discuss the specific features concerning the treatment of this unusual case.

Synchronous nephrectomy and right hepatectomy for metastatic chromophobe renal cell carcinoma: report of a case and review of the literature.

The prognosis of metastatic renal cell carcinoma is poor, since non-operative modalities for advanced renal carcinoma have failed to yield effective results. In fact, there is no indication for radiotherapy, except for palliative treatment of symptomatic bone metastases, and systemic chemotherapy is not effective. Despite the promising early results with immunotherapy, a complete response occurs in less than 15% of patients and is rarely lasting. Surgery, when indicated, seems to be the only therapeutic option possible. Liver metastases occur in 20% of cases and are often multiple. Experience with hepatectomy for metastatic renal tumours has rarely been reported. Not only does a small group of patients have isolated liver metastases that may be treated with radical surgery, but also extrahepatic metastases ordinarily coexist at the time of diagnosis. We report a case of a 55-year-old man with a chromophobe renal cell carcinoma with a single synchronous hepatic metastasis that were treated simultaneously with radical nephrectomy and right hepatectomy. To the best of our knowledge this is the first case of a single metastasis of a chromophobe renal cell carcinoma treated with synchronous kidney and hepatic resection.

[Laparoscopic colorectal surgery: is the "learning curve" necessary?]. / Chirurgia colo-rettale laparoscopica: e necessaria la "curva di apprendimento"?

AIM OF THE STUDY: To present the early experience of the Authors' division in the field of colorectal laparoscopic surgery, in order to evaluate the so-called "learning curve". MATERIALS AND METHOD: From February 2003 to May 2004, we have performed 220 surgical procedures for colorectal pathology: 63 were conducted by a laparoscopic approach with 10 patients who, converted to a laparotomic procedure in theatre, were not taken under consideration. The present work is thus based on a population of 53 patients, 27 men and 26 women, at a median age of 64.4 y.o. (range 42-81). RESULTS: We performed 1 total colectomy, 24 right hemicolectomy, 1 resection of the splenic flexure, 12 left hemicolectomy (in 1 case a left hepatic lobectomy was associated), 11 anterior resection of the rectum, 1 Hartmann' sigmoid resection and 3 abdomino-perineal resection. Mean operative time was 200.34 +/- 64.17 min, while the mean hospital stay was 6.44 +/- 2.68 days. Peri-operative mortality was 0%, 30-days mortality was 1/53 patients (9%) while morbidity was 5/53 patients (9.4%): in 2 cases reintervention was necessary. DISCUSSION: From the evaluation of the results, we found some significant data: first, the conversion rate was similar to those reported by other authors, so also the mortality and morbidity rates. CONCLUSIONS: The advantages of the laparoscopic technique, indirectly documented by shorter in-hospital stay. At least for patients submitted to right or left hemicolectomy without complications (5.5 e 5.7 days, respectively), could be seen also after only a 1 year of activity. As far as the "learning curve" is concerned, dividing our activity into 3 times, we verified a progressive shortening of the operative time and, at least for the patients submitted to a right emicolecomy, also of the morbidity rates.

Intrahepatic rupture of a caudate lobe adenoma in liver adenomatosis.

Hepatic adenomatosis is a rare benign disease that is more common in young and middle-aged women who are non-steroid dependent; it is usually symptomatic, progressive, and susceptible to hemorrhagic complications. Malignant transformation within adenomas is rare. The management of hepatic adenomatosis remains difficult due to the absence of predictive signs of complications, other than the size of the adenomas. Resective surgery is usually indicated, but liver transplantation could be an indication in highly symptomatic or progressive forms of the disease and represents the treatment of choice in cases of malignant transformation. We report a case of intrahepatic rupture of a caudate lobe adenoma which occurred in an adolescent with hepatic adenomatosis; we also present a brief review of the literature.

Spleen-preserving total pancreatectomy with conservation of the spleen vessels:: operative technique and possible indications.

Conventional distal pancreatectomy (cDP) and total pancreatectomy (cTP) also involve removal of the spleen. The spleen, however, is an important organ in the immunologic defense of the host and is worthy of preservation if this can be safely achieved. We performed a spleen-preserving total pancreatectomy (SPTP), with good results, in a Caucasian woman, 66-year-old, affected by pancreatic metastases of renal clear cell carcinoma. This is the first report of a SPTP for pancreatic metastases to our knowledge, and we therefore wish to describe the surgical technique and to suggest the possible indications for this new technique.