I would like to express my condolences to the earthquake victims in the southeastern areas of Turkey. The father in this image still holds her daughter's hand after her death. This was the most memorable image of this disaster.
These are the images of a patient who underwent an open partial nephrectomy for a cT2 kidney tumor. The pathology report seems fine, with negative surgical margins.
Images at 3 months after the operation was unremarkable.
However, at 9 months, a local recurrence and lung metastasis were seen.
The surgeon has to make a hard choice. If he does not bear the risk of challenging surgery with potential complications, the patient takes the risk of chronic kidney disease in the following years.
3 metanalyses comparing partial and radical nephrectomies for cT2 tumors, and 2 of them are given in the following slides: Briefly, despite no difference in terms of cancer-specific survival, overall survival is better for patients undergoing partial nephrectomy.
I would like to mention here a case series from a robotic club. No differences regarding metastasis and recurrence were noted.
No difference was noted regarding overall and disease-free survivals for the pT2 and pT3 groups.
On the other hand, renal function was much better in the partial nephrectomy group.
There are numerous case series in the literature with a similar outcomes.
However, these outcomes belong to the pioneering people in this field of surgery. This is similar to a boat with a lousy hull. With this kind of hull, it is not possible to sail. Thus, it does not represent the expected outcomes.
Back to the case, despite systemic treatment, the mass increased to 4.5 cm, and I performed an open radical nephrectomy.
