Tumor Enucleation of Renal Cell Carcinoma in a Solitary Kidney

Special Article - Surgical Case Reports

Austin J Surg. 2015;2(3): 1059.

Tumor Enucleation of Renal Cell Carcinoma in a Solitary Kidney

Farber NJ, Faiena I, Parihar JS and Singer EA*

Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, USA

*Corresponding author: Singer EA, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street Room 4563, New Brunswick, NJ 08903, USA

Received: January 19, 2015; Accepted: April 20, 2015; Published: April 28, 2015


We describe the case of a 57 year old man with a solitary kidney after undergoing resection of a Wilm’s tumor as a child and a recent left partial colectomy who presents with an incidentally found clinical T1b renal mass. The patient underwent tumor enucleation and had no change in his renal function twelve days after surgery as compared to his preoperative baseline, highlighting the additional nephron-sparing associated with tumor enucleation as compared to partial nephrectomy that includes a gross margin of normal parenchyma.

Keywords: Renal cell carcinoma; Solitary kidney; Nephron-sparing surgery; Enucleation; Partial nephrectomy


AUA: American Urologic Association; CKD: Chronic Kidney Disease; CT: Computed Tomography; PN: Partial Nephrectomy; RN: Radical Nephrectomy; TE: Tumor Enucleation


Renal cell carcinoma is the third most common cancer of the genitourinary system and in 2014 accounted for an estimated 63,920 new cases and 13,860 deaths with a 2-4% annual increase in incidence over the past several decades [1]. With the ubiquity of abdominal imaging in modern medicine, many renal masses are detected incidentally and so the management of a clinical stage 1 renal mass (<7.0cm) is an important facet of urologic practice. Nephron-sparing surgery is the preferred approach to a clinical T1 mass, with partial nephrectomy the gold standard. However, Tumor Enucleation (TE) is an alternative approach to nephron-sparing surgery that spares additional nephrons over other methods.

Case Presentation

A 57 year-old man was referred to our Comprehensive Cancer Center for evaluation of an incidentally found left renal mass in a solitary kidney. The patient’s past medical history included a rightsided nephroblastoma (Wilm’s tumor) treated with right radical nephrectomy as a child and a recent diagnosis of colon cancer statuspost left partial colectomy and primary anastomosis at the splenic flexure six weeks prior to his initial visit. His renal mass was found during staging for his colon cancer, which was identified during an evaluation for a 40-pound unintentional weight loss. His abdominal Computed Tomography (CT) scan showed an enhancing, 4.2cm upper pole left kidney mass, suspicious for renal cell carcinoma (Figures 1&2). After counseling, the patient elected to undergo surgical excision of the mass. An open surgical approach was recommended given his two prior open operations. Preoperative vital signs, basic metabolic panel, and complete blood count were within normal limits. Metastatic work-up was negative. Repeat imaging prior to open partial nephrectomy was obtained to evaluate for postcolectomy changes. His renal mass was stable in size and surgical clips were noted between the posterior colonic mesentery and anterior Gerota’s fascia.

Citation: Farber NJ, Faiena I, Parihar JS and Singer EA. Tumor Enucleation of Renal Cell Carcinoma in a Solitary Kidney. Austin J Surg. 2015;2(3): 1059. ISSN: 2381-9030.