Overcoming fear of developing country: A case report of retroperitoneal laparoscopic partial nephrectomy for T3A renal cell carcinoma

INTRODUCTION

Renal cell carcinoma poses significant challenges in kidney diseases, particularly in the context of the T3 stage, where treatment strategies remain controversial. The utilization of laparoscopic partial nephrectomy, particularly in developing countries, has been restricted for such patients, primarily due to limited infrastructure and concerns about recurrence risk and long-term pathologic outcomes.

PRESENTATION OF CASE

In this report, we present a case of a 64-year-old male diagnosed with T3aN0M0 renal cell carcinoma (RCC). Abdominal computed tomography revealed a 5.2 × 5.2 × 5.1 cm mass on the right upper part of the kidney with a possible thrombus in the superior renal polar vein. The patient underwent successful treatment with retroperitoneal laparoscopic partial nephrectomy (LPN), leading to the preservation of kidney function with <4 mL/min/1.73 m2 GFR reduced after one year postoperative (estimated GFR from 85 mL/min/1.73 m2 to 81.79 mL/min/1.73 m2). The patient was discharged after three days; no recurrence was observed during the follow-up.

DISCUSSION

For stage T3a RCC, studies show that LPN induces comparable long-term outcomes to radical nephrectomy, with advantages such as preserved kidney function, reduced operative time, blood loss, and shorter hospital stays. However, due to infrastructure constraints and limited access to robotic-assisted surgery in our country, coupled with concerns about tumor recurrence, laparoscopic radical nephrectomy is predominantly employed for similar patients. Our case represents one of the very first cases in which we successfully treated a patient diagnosed with T3a RCC using retroperitoneal laparoscopic partial nephrectomy.

CONCLUSION

Laparoscopic partial nephrectomy is a reliable choice for T3aN0M0 RCC with good long-term outcomes and preserved renal function, especially by the hands of an experienced laparoscopic surgeon.

Long-term clinical impact of serum albumin in coronary artery disease patients with preserved renal function

BACKGROUND AND AIMS

Low serum albumin level is reportedly associated with worse clinical outcomes in patients with chronic kidney disease (CKD). However, associations between decreased serum albumin level and outcomes in non-CKD patients with coronary artery disease (CAD) remain unclear. Therefore, we aimed to evaluate the prognostic value of serum albumin concentrations in stable CAD patients with preserved renal function.

METHODS AND RESULTS

We studied 1316 patients with CAD and preserved renal function (estimated glomerular filtration rate ≥60 mL/min/1.73 m²) who underwent their first PCI between 2000 and 2011 and had data available for pre-procedural serum albumin. Patients were assigned to quartiles based on pre-procedural albumin concentrations. The incidence of major adverse cardiac events (MACE), including all-cause death and non-fatal myocardial infarction, was evaluated. Mean albumin concentration was 4.1 ± 0.4 g/dL. During the median follow-up of 7.5 years, 181 events occurred (13.8%). Kaplan-Meier curves revealed that patients with decreased serum albumin concentrations showed a higher event rate for MACE (log-rank, p < 0.0001). Using the highest tertiles (>4.3 g/dL) as reference, adjusted hazard ratios were 1.97 (95% CI, 1.12-3.55), 1.77 (95% CI, 0.99-3.25), and 1.19 (95% CI, 0.68-2.15) for serum albumin concentrations of <3.9, 3.9-4.0, and 4.1-4.3 g/dL, respectively. Decreased serum albumin concentration was associated with MACE even after adjusting for other independent variables (HR, 2.21 per 1-g/dL decrease; 95% CI, 1.37-3.56, p = 0.001).

CONCLUSION

Decreased serum albumin concentration independently predicted worse long-term prognosis in non-CKD patients after PCI. Pre-procedural serum albumin concentration could offer a useful predictor for patients with CAD and preserved renal function.