Robotic treatment of oligometastatic kidney tumor with synchronous pancreatic metastasis: case report and review of the literature.

摘要: The management of metastatic Renal Cell Carcinoma (RCC) has changed dramatically in the last 20 years, and role surgery immunotherapy’s era is under debate. Metastatic lesions interesting pancreas are infrequent, but those harbouring from RCC have an high incidence. If metachronous resections not rare, synchronous resection primary its pancreatic metastasis uncommonly reported, accounts for a bad prognosis. We report case 68 years old woman, who presented hematuria at hospital incoming, with radiological appearance 13 cm left renal mass, 2.5 cm single tail metastasis. Work-up staging ruled out other distant metastases, urothelial cancer there was no evidence inferior vena cava thrombosis. choose 5-port trans-peritoneal robotic approach using lazy right lateral decubitus. Synchronous radical nephrectomy spleen-sparing performed. mass completely enucleated parenchyma latero-medial dissection. Peri-operative hemoglobine loss 2.4 g/dL. Total operative time 213 min. No post-operative complications were recorded patient discharged 7th day. Histopathological examination showed pT2b N0 M1 RCC, Fuhrman grade II, metastasis; both, had same histological characteristics negative surgical margins. After 9 months disease recurrence studies. rationale removal disseminated tumor, followed by immunotherapy, includes improving prognosis enhancing potential immune-mediated response to systemic treatment. A procedure can adequately preserve immunologic capabilities. In our experience, correct assessment pre-operative imaging data surgeon skills seem play key success these procedures. Robotic seems enhance possibility control multiple vessels encountered during Such conservative may be helpful future research aimed uncovering biological features, also leading better targeted preventive interventions more individualized effective treatments.