Renal-cell carcinoma: bench surgery, followed by autotransplantation for localized disease

Abstract

Objective. The more and more increasing availability of hemodialysis has limited the number of bench surgeries followed by autotransplantation for complex cases of renal-cell carcinoma (RCC) in solitary kidneys during the 1980's and 1990's. However, during recent years, quality of life issues, cost aspects, as well as the relatively high attrition rate under long-term hemodialysis have sparked renewed interest in organ-preserving bench surgery strongly driven by patients' demands.

Material and Methods. We reviewed our experience with 36 recent cases of bench surgery and autotransplantation for complex RCC, collected prospectively in our database.

Results. All tumors were invariably RCCs. Thirty-three, 3, and 1 cases were diagnosed as having clear-cell, papillary, and chromophobe carcinomas, respectively. All cases were preoperatively examined by imaging procedures as «organ-confined», whereas definitive pathology revealed a tumor stage ranging from pT1 to pT3a, always pN0, and M0. There were few surgical complications that were significant. One perioperative myocardial infarction-induced death occurred on postoperative day 5, one kidney was lost due to transplantation failure, and one patient was on hemodialysis for 3 weeks until complete functional recovery occurred. After a relatively short median follow-up of 2,8 years, one patient had distant metastasis and another patient had a recurrent renal tumor after 13 months.

Discussion. Analysis of our personal experience with 21 retrospective cases from 1992 to 2000 and 36 prospective cases (this series) from 2001 to 2006 has shown that bench surgery and autotransplantation for complex cases of RCC are feasible and probably cost effective. There is a clear need for strict inclusion criteria, such as an imperative indication and organ-confined (hence, surgically curable disease) stages, a multidisciplinary team approach, suitable infrastructure, and experience in major surgical procedures. If these criteria are met, bench surgery followed by autotransplantation has become again a valuable last resort and is apparently safe.