V10-12: Robot-assisted cytoreductive nephrectomy and resection of pelvic metastasis after renal cryoablation
Tumor seeding or intraperitoneal spread of disease occurs rarely after percutaneous biopsy or ablation of renal cell carcinoma. We present a case of robot-assisted cytoreductive nephrectomy and resection of pelvic metastasis after percutaneous cryoablation of renal cell carcinoma.
A 69 year old male was referred to City of Hope with a prior history of percutaneous cryoablation of a 3 cm biopsy-proven clear cell renal cell carcinoma. At 4 and 9 months after ablation, CT scan showed no evidence of disease recurrence. At 13 months after surgery, a CT showed a 3 cm renal mass suspicious for recurrent cancer and a 3.8 cm mass involving the right seminal vesicle. Pulmonary metastases were also found. CT-guided biopsy of both masses confirmed renal cell carcinoma.
After discussion of treatment options, cytoreductive robot-assisted left radical nephrectomy with pelvic mass resection was performed. The renal cancer was adherent to the colonic mesentery and the mesentery was widely resected in this area. After nephrectomy was complete, the patient was re-positioned into dorsal lithotomy position and the pelvic mass was resected. The right seminal vesicle was resected in order to ensure that the disease was completely resected. The postoperative course was uncomplicated and the patient was discharged on postoperative day 2. Final pathology results demonstrated pT4 grade 4 clear cell renal cell carcinoma with sarcomatoid features, locally invading the colonic mesentery.
Though rare, pelvic metastasis may occur after cryoablation of renal cell carcinoma. Robot-assisted techniques may be applied in this situation.