Our initial experience with partial nephrectomy in Najaf, Iraq

Abstract EN

Introduction : due to the increased use of modern diagnostic imaging techniques ; a growing number of small renal tumors are being diagnosed incidentally.

The standard treatment for these small lesions is partial nephrectomy, with equivalent oncologic results to that of radical nephrectomy, and better renal function preservation. Patients and methods : Fifteen patients with renal lesions, ranging in size from 4 to 7.5 cm, had been submitted to our study; with their ages ranging from 22 to 80 years.

Partial nephrectomy using manual compression was done.

Patients are then followed 3 monthly by U \ S checking of renal dimension, echogenicity and for recurrence.

The follow up period ranges between 3- 24 months.

Results : of 15 patients enrolled in our study; the provisional diagnosis was hydatid cyst in 3 patients, and renal tumor in 12 patients.

From those 12 cases with provisional diagnosis of renal tumors : 2 cases had their histopathology proved to be hydatid cyst in one patient, and chronic inflammatory lesion in the other, and the other 10 cases were malignant renal tumors.

Two patients (16.6 %) with provisional diagnosis of renal tumor had proved to be malignant on frozen sections with positive margins, for which further resection was done and the new edges proved to be negative.

All other lesions (83.4 %) with provisional diagnosis of renal tumor were proved to be malignant on frozen section with negative margins Conclusions : manual compression is the technique of choice for control of bleeding in partial nephrectomy for polar or peripheral lesion, with zero warm ischemia.

Hydatid cyst resection is a feasible surgical procedure for polar or peripherally situating cyst, leaving no chance for recurrence.

Longer follow up is needed to make sure that the incidence of recurrence and progression remains stable over time, and to confirm that the higher incidence rate of positive surgical margin does not translate into a worse survival rate.