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Abstract: The patient was found to have a “renal cyst” 3 years ago and had not been reexamined for 3 years since then. The patient underwent robotic-assisted laparoscopic partial nephrectomy, and the postoperative pathology confirmed that it was papillary renal cell carcinoma, which is a relatively common type of kidney cancer. After surgery, the patient recovered well, the tumor was completely removed, the left kidney was preserved, and there was no local recurrence on review.
Basic information】Male, 30 years old
Disease Type】Papillary renal cell carcinoma
Hospital】The First Affiliated Hospital of Zhejiang University School of Medicine
Date of consultation】January 2020
Treatment plan】Surgical treatment (robotic-assisted laparoscopic partial nephrectomy)
Treatment period】7 days hospitalization, 3 months postoperative review, lifelong follow-up
Results】Tumor was completely removed, the left kidney was preserved, and there was no local recurrence
I. Initial consultation
The patient came to our hospital for further diagnosis and treatment of a “left kidney cyst”, about 5 cm in size, which was detected by ultrasound at a local hospital one month ago. After asking about his medical history, the patient said that the “kidney cyst” was found 3 years ago by physical examination and was about 1.5cm in size at that time, but he did not review it because he had not had any uncomfortable symptoms. The patient received an enhanced CT examination of the kidney, which indicated a mass in the lower pole of the left kidney. The mass was solid rather than cystic, so it was obviously not a renal cyst and was suspected to be renal cancer, which required surgery.
Renal enhancement CT performance (left is flat scan, right is enhancement, white arrow is tumor lesion)
II. Treatment process
The patient was then arranged to be hospitalized and informed of the respective advantages and disadvantages of radical nephrectomy and partial nephrectomy, and the patient requested to keep the kidney. After the patient agreed to the operation, the preoperative examination was improved and no absolute contraindication to the operation was found, and then the patient was arranged to undergo robotic-assisted laparoscopic partial nephrectomy, during which the tumor was successfully removed and the kidney was preserved.
III. Treatment effect
The patient’s surgery was successful, the tumor was completely removed and the left kidney was preserved. The patient was bedridden for 3 days after surgery, and started to get out of bed on the 4th day after surgery, and recovered well after surgery. The postoperative pathology report confirmed that the tumor was papillary renal cell carcinoma, and the tumor stage was T1bN0M0. The drainage tube and catheter were removed on the 4th day after surgery, and the patient was discharged after 7 days of hospitalization. Three months after surgery, the patient was reviewed at the outpatient clinic, and the tumor was well controlled with no local recurrence, and is now under continuous outpatient follow-up.
IV. Notes
We are glad that the patient’s disease is under control after treatment, but the patient needs to be bedridden for 3-5 days after partial nephrectomy. During this period, special attention should be paid to prevent deep vein thrombosis in the lower limbs, and elastic stockings can be worn. Active or passive movement of the lower limbs during bed rest, massage of the lower limbs, especially the calf gastrocnemius muscle. Pickled, preserved and smoked foods are prone to aflatoxin and nitrite, so eat less or not. In addition, postoperative review is very important, generally requires a review once every 3 months within 2 years after surgery, once every 6 months from 2 to 5 years after surgery, and once a year after 5 years after surgery, the review includes urological ultrasound, kidney function, etc. In addition, patients also need to have a health checkup once a year.
V. Personal insight
Kidney cancer is one of the most common tumors of the urinary system, and most patients are detected by screening during health checkups. In this case, the patient’s kidney abnormality was detected during the physical examination 3 years ago, but due to the diagnosis of renal cyst, the patient did not have further examination, which led to the disease progression; fortunately, the tumor did not break through the renal envelope, so the prognosis is relatively good. In conclusion, it is recommended to strengthen physical examination and if abnormalities are found in physical examination, it is recommended to go to a specialized hospital for further detailed examination and clear diagnosis.