Renal Cell Carcinoma-Angioinfarction and Adjunctive Nephrectomy

Kim, Bup Wan; Lee, Sung Choon

Abstract

In 1969 Lalli and associates introduced angioinfarction of kidney as a possible therapeutic modality. Recently Wallace and associates suggested that infarction followed by nephrectomy may activate the immune system resulting in improved survival of patients with stage IV renal cell carcinoma. From 1982 we began a study using preoperative infarction in 21 patients without evidence of metastasis as well as those with stage IV disease. Post operatively all patients were given medroxyprogesterone acetate and testosterone propionate as adjuvant therapy. The authors have collected a series of 46 cases of renal cell carcinoma during the past l0 years from April, 1975 through March, 1985. Conclusions; 1. Two year survival rate according to tumor stage was 86% in stage II 67% in stage III in stage III and 0% in stage IV. 2. The value of angioinfarction; a. Almost all patients displayed acute postembolization syndrome consisting of fever, leukocytosis and pain, which were usually resolved by conservative treatment except for 3 cases treated surgically for the displacement of stee1 coils into the hypogastric and femoral artery. b. We believe that embolization facilitated nephrectomy probably due to tissue edema, although this could not be proved by objective measurement of the length of the length of time required for the operation and blood loss. 3. The role of adjunctive nephrectomy in patients with metastatic renal cell carcinoma; a. Mean survival was 8.5 months in which radical nephrectomy was performed in comparison with 3.8 months in which simple nephrectomy was done or only symptomatic treatment was given. b. There was only one complete remission which lasted 6 months. Two patients and stable disease and markedly improved symptom for at least 3 months, but eventually all patients showed evidence of progression.