Management of synchronous renal cell carcinoma and aortic disease

Scott F. Howe, Rodney J. Taylor, Brian G. Halloran, Seth Smith, Thomas G. Lynch, Bernard Timothy Baxter

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: We have noted a significant incidence of renal cell carcinoma (RCC) detected during evaluation for aneurysmal and aortoiliac occlusive disease. The approach to synchronous malignancy and aortic disease (staged versus concurrent resection) is controversial, as is the management of incidental RCC (partial versus radical nephrectomy). Patients and methods: We reviewed our experience with incidental RCC in patients undergoing aortic reconstruction between 1991 and 1994. Ninety-seven patients underwent aortic reconstruction for aneurysmal (72), occlusive (20), or embolic disease (5) during the time frame under review. All were men. Of the 80 preoperative computerized tomographic (CT) scans obtained, 7 (9%) demonstrated renal lesions suspicious for RCC. All lesions were explored and excised by partial or radical nephrectomy before heparinization and completion of the planned aortic procedure. Results: The overall mortality rate was 3%. None of the deaths occurred in patients undergoing combined procedures. Four partial and three radical nephrectomies were performed. Of the 7 renal lesions, 2 were complex cysts and 5 were RCC. Both patients with complex cysts were treated with wedge resection. One patient required surgical drainage of a wound abscess after partial nephrectomy. No significant differences were found between preoperative (1.4 ± 0.1 mg/dL) and postoperative (1.8 ± 0.2 mg/dL) creatinine levels following combined procedures. On follow-up CT scans done at 6-month intervals (mean follow-up 24 months), no evidence exists of recurrence, metastasis, or graft infection. Conclusions: This patient population demonstrated an unexpectedly high prevalence of incidental RCC (5 of 80 CTs, 6%). No increase in mortality was found when RCC and aortic disease were treated at the same operation. While partial nephrectomy was associated with one wound infection in this series, it is an effective treatment for small incidental RCC and may avoid unnecessary nephrectomy in patients with benign disease. Based on the high incidence of RCC in this population, we recommend exploration of all suspicious lesions. Nephrectomy can be performed safely in the same setting as aortic reconstruction. Because underlying renal dysfunction is not uncommon in patients with aneurysmal and aortoiliac occlusive disease, nephron-sparing surgery should be considered.

Original languageEnglish (US)
Pages (from-to)231-234
Number of pages4
JournalThe American Journal of Surgery
Volume170
Issue number2
DOIs
StatePublished - Aug 1995

Fingerprint

Aortic Diseases
Renal Cell Carcinoma
Nephrectomy
Kidney
Cysts
Mortality
Incidence
Nephrons
Wound Infection
Abscess
Population
Drainage
Creatinine
Neoplasm Metastasis
Transplants
Recurrence

ASJC Scopus subject areas

  • Surgery

Cite this

Management of synchronous renal cell carcinoma and aortic disease. / Howe, Scott F.; Taylor, Rodney J.; Halloran, Brian G.; Smith, Seth; Lynch, Thomas G.; Baxter, Bernard Timothy.

In: The American Journal of Surgery, Vol. 170, No. 2, 08.1995, p. 231-234.

Research output: Contribution to journalArticle

Howe, Scott F. ; Taylor, Rodney J. ; Halloran, Brian G. ; Smith, Seth ; Lynch, Thomas G. ; Baxter, Bernard Timothy. / Management of synchronous renal cell carcinoma and aortic disease. In: The American Journal of Surgery. 1995 ; Vol. 170, No. 2. pp. 231-234.
@article{13949547d71f4e0285f640aef0ef23a1,
title = "Management of synchronous renal cell carcinoma and aortic disease",
abstract = "Background: We have noted a significant incidence of renal cell carcinoma (RCC) detected during evaluation for aneurysmal and aortoiliac occlusive disease. The approach to synchronous malignancy and aortic disease (staged versus concurrent resection) is controversial, as is the management of incidental RCC (partial versus radical nephrectomy). Patients and methods: We reviewed our experience with incidental RCC in patients undergoing aortic reconstruction between 1991 and 1994. Ninety-seven patients underwent aortic reconstruction for aneurysmal (72), occlusive (20), or embolic disease (5) during the time frame under review. All were men. Of the 80 preoperative computerized tomographic (CT) scans obtained, 7 (9{\%}) demonstrated renal lesions suspicious for RCC. All lesions were explored and excised by partial or radical nephrectomy before heparinization and completion of the planned aortic procedure. Results: The overall mortality rate was 3{\%}. None of the deaths occurred in patients undergoing combined procedures. Four partial and three radical nephrectomies were performed. Of the 7 renal lesions, 2 were complex cysts and 5 were RCC. Both patients with complex cysts were treated with wedge resection. One patient required surgical drainage of a wound abscess after partial nephrectomy. No significant differences were found between preoperative (1.4 ± 0.1 mg/dL) and postoperative (1.8 ± 0.2 mg/dL) creatinine levels following combined procedures. On follow-up CT scans done at 6-month intervals (mean follow-up 24 months), no evidence exists of recurrence, metastasis, or graft infection. Conclusions: This patient population demonstrated an unexpectedly high prevalence of incidental RCC (5 of 80 CTs, 6{\%}). No increase in mortality was found when RCC and aortic disease were treated at the same operation. While partial nephrectomy was associated with one wound infection in this series, it is an effective treatment for small incidental RCC and may avoid unnecessary nephrectomy in patients with benign disease. Based on the high incidence of RCC in this population, we recommend exploration of all suspicious lesions. Nephrectomy can be performed safely in the same setting as aortic reconstruction. Because underlying renal dysfunction is not uncommon in patients with aneurysmal and aortoiliac occlusive disease, nephron-sparing surgery should be considered.",
author = "Howe, {Scott F.} and Taylor, {Rodney J.} and Halloran, {Brian G.} and Seth Smith and Lynch, {Thomas G.} and Baxter, {Bernard Timothy}",
year = "1995",
month = "8",
doi = "10.1016/S0002-9610(99)80293-1",
language = "English (US)",
volume = "170",
pages = "231--234",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Management of synchronous renal cell carcinoma and aortic disease

AU - Howe, Scott F.

AU - Taylor, Rodney J.

AU - Halloran, Brian G.

AU - Smith, Seth

AU - Lynch, Thomas G.

AU - Baxter, Bernard Timothy

PY - 1995/8

Y1 - 1995/8

N2 - Background: We have noted a significant incidence of renal cell carcinoma (RCC) detected during evaluation for aneurysmal and aortoiliac occlusive disease. The approach to synchronous malignancy and aortic disease (staged versus concurrent resection) is controversial, as is the management of incidental RCC (partial versus radical nephrectomy). Patients and methods: We reviewed our experience with incidental RCC in patients undergoing aortic reconstruction between 1991 and 1994. Ninety-seven patients underwent aortic reconstruction for aneurysmal (72), occlusive (20), or embolic disease (5) during the time frame under review. All were men. Of the 80 preoperative computerized tomographic (CT) scans obtained, 7 (9%) demonstrated renal lesions suspicious for RCC. All lesions were explored and excised by partial or radical nephrectomy before heparinization and completion of the planned aortic procedure. Results: The overall mortality rate was 3%. None of the deaths occurred in patients undergoing combined procedures. Four partial and three radical nephrectomies were performed. Of the 7 renal lesions, 2 were complex cysts and 5 were RCC. Both patients with complex cysts were treated with wedge resection. One patient required surgical drainage of a wound abscess after partial nephrectomy. No significant differences were found between preoperative (1.4 ± 0.1 mg/dL) and postoperative (1.8 ± 0.2 mg/dL) creatinine levels following combined procedures. On follow-up CT scans done at 6-month intervals (mean follow-up 24 months), no evidence exists of recurrence, metastasis, or graft infection. Conclusions: This patient population demonstrated an unexpectedly high prevalence of incidental RCC (5 of 80 CTs, 6%). No increase in mortality was found when RCC and aortic disease were treated at the same operation. While partial nephrectomy was associated with one wound infection in this series, it is an effective treatment for small incidental RCC and may avoid unnecessary nephrectomy in patients with benign disease. Based on the high incidence of RCC in this population, we recommend exploration of all suspicious lesions. Nephrectomy can be performed safely in the same setting as aortic reconstruction. Because underlying renal dysfunction is not uncommon in patients with aneurysmal and aortoiliac occlusive disease, nephron-sparing surgery should be considered.

AB - Background: We have noted a significant incidence of renal cell carcinoma (RCC) detected during evaluation for aneurysmal and aortoiliac occlusive disease. The approach to synchronous malignancy and aortic disease (staged versus concurrent resection) is controversial, as is the management of incidental RCC (partial versus radical nephrectomy). Patients and methods: We reviewed our experience with incidental RCC in patients undergoing aortic reconstruction between 1991 and 1994. Ninety-seven patients underwent aortic reconstruction for aneurysmal (72), occlusive (20), or embolic disease (5) during the time frame under review. All were men. Of the 80 preoperative computerized tomographic (CT) scans obtained, 7 (9%) demonstrated renal lesions suspicious for RCC. All lesions were explored and excised by partial or radical nephrectomy before heparinization and completion of the planned aortic procedure. Results: The overall mortality rate was 3%. None of the deaths occurred in patients undergoing combined procedures. Four partial and three radical nephrectomies were performed. Of the 7 renal lesions, 2 were complex cysts and 5 were RCC. Both patients with complex cysts were treated with wedge resection. One patient required surgical drainage of a wound abscess after partial nephrectomy. No significant differences were found between preoperative (1.4 ± 0.1 mg/dL) and postoperative (1.8 ± 0.2 mg/dL) creatinine levels following combined procedures. On follow-up CT scans done at 6-month intervals (mean follow-up 24 months), no evidence exists of recurrence, metastasis, or graft infection. Conclusions: This patient population demonstrated an unexpectedly high prevalence of incidental RCC (5 of 80 CTs, 6%). No increase in mortality was found when RCC and aortic disease were treated at the same operation. While partial nephrectomy was associated with one wound infection in this series, it is an effective treatment for small incidental RCC and may avoid unnecessary nephrectomy in patients with benign disease. Based on the high incidence of RCC in this population, we recommend exploration of all suspicious lesions. Nephrectomy can be performed safely in the same setting as aortic reconstruction. Because underlying renal dysfunction is not uncommon in patients with aneurysmal and aortoiliac occlusive disease, nephron-sparing surgery should be considered.

UR - http://www.scopus.com/inward/record.url?scp=0029100595&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029100595&partnerID=8YFLogxK

U2 - 10.1016/S0002-9610(99)80293-1

DO - 10.1016/S0002-9610(99)80293-1

M3 - Article

C2 - 7631938

AN - SCOPUS:0029100595

VL - 170

SP - 231

EP - 234

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 2

ER -