A 42 year old young man came to our International Oncology Centre, Fortis Hospital, Noida with a large tumor in his kidney. He had only one kidney since birth. It was a large tumor measuring 10 x 8 cm arising from the upper pole of the right kidney. The challenge was to save the solitary kidney and remove the tumor completely. This process is known as "Nephron Sparing Surgery" or "Partial Nephrectomy". It is usually recommended for small tumour of <3 cm in size. Here the challenge was that the tumor was large and the patient had only one kidney. If that kidney was removed, he would have to be on life long dialysis or had to undergo for renal transplant a few years later if no spread of disease occured. Both the dialysis and transplant are costly and also need donor from the family.
Dr. Rajeev Kumar, Senior Consultant - Surgical Oncology, International Oncology Centre, Fortis Hospital, Noida and his team accepted the challenge to save the kidney. His CT scan showed that the tumor was getting its major blood supply from an accessory artery arising from aorta in addition to normal renal artery.
Our expert Interventional Radiologist occluded this accessory artery with coils before the surgery so that the main blood supply to tumor was cut off and the vascularity of tumor could be reduced which was helpful while operating. As the tumor had many large dilated vessels which could bleed profusely at the time of surgery, the tumor vessel was embolized 48 hours before the surgery. There was a large tumor coming from the upper pole of right kidney with dilated vessels. The tumor was mobilized from all around and the main renal artery was clamped. The kidney was cooled using ice slush. This process is known as cold ischemia, which helps surgeons to operate without much blood loss. The tumor was removed successfully with cancer free margins and rest of the kidney could be saved. The patient was discharged after a week of surgery passing normal urine and in good general condition.