Partial nephrectomy in two patients with known T3a tumours involving the renal vein

OBJECTIVE To present two patients with T3a tumours involving the renal vein who underwent nephron-sparing surgery (NSS) for imperative reasons. PATIENTS AND METHODS Retrospective chart review of patients who underwent NSS for renal cell carcinoma (RCC) with known renal vein tumour thrombus (RVTT). Both patients underwent open partial nephrectomy and renal vein thrombectomy of a solitary kidney. Primary outcomes of the study include radiographic evidence of recurrence, haemodialysis requirement and estimated glomerular filtration rate (eGFR) before and after surgery. RESULTS Patient 1 is 24 months from NSS and has no evidence of recurrence based on CT scan. His final pathology revealed a 9-cm, T3a, clear cell, Fuhrman grade II carcinoma. He spent 42 days on haemodialysis and is now off all dialysis. His preoperative and most recent eGFR are 48 and 23 mL/min/1.73 m(2) based on the Modification of Diet in Renal Disease (MDRD) equation and 69.4 and 29.8 mL/min by the Cockcroft-Gault equation. Patient 2 is 9 months from NSS and has no evidence of recurrence based on CT scan. Her final pathology revealed a 6-cm, T3a, clear cell, Fuhrman grade II-III carcinoma. She spent 30 days on haemodialysis and is now off all dialysis. Her preoperative and most recent eGFR are 58 and 30 mL/min/1.73 m(2) based on the MDRD equation and 62.2 and 32.8 mL/min by the Cockcroft-Gault equation. CONCLUSION Based on our review, preservation of renal function and favourable oncological outcome can be accomplished with NSS in patients with known stage T3a RCC with RVTT and should be considered in carefully selected patients.