Laparoscopic management of indeterminate renal cysts.
OBJECTIVE
We present our follow-up of patients with indeterminate renal cysts who were initially evaluated laparoscopically. We specifically address those patients discovered to have cystic renal cell carcinoma by laparoscopy and the incidence of tract seeding, local recurrence, and distant metastases.


METHODS
Between July 1993 and September 1997, 35 patients with indeterminate renal cysts were evaluated laparoscopically. Under laparoscopic visualization, the cyst was located and aspirated, the fluid was sent for cytology, and the floor of the cyst was biopsied. The tissue was then evaluated immediately by one of our genitourinary pathologists, and an intraoperative decision was made. Four patients were found to have cystic renal cell carcinoma and underwent partial or radical nephrectomy in the same setting. An additional patient had a delayed partial nephrectomy 10 days after laparoscopy as a result of change in the final pathology reading. The patients with malignancy were followed with chest x-ray, liver function tests, abdominal computed tomography (CT) scans, and physical examination every 3 months for the first year and then every 6 months thereafter. The average follow-up was 20.2 months (range 8 to 30).


RESULTS
Of the 35 patients evaluated in this manner, 5 (14%) were found to have cystic renal cell carcinoma. There has been no evidence of local recurrence or metastatic disease to date. Physical examinations, chest x-rays, liver function tests, and abdominal CT scans all remain negative.


CONCLUSIONS
Initial laparoscopic evaluation of complex cysts can save the patient from undergoing needless open surgery. Laparoscopic biopsy of cystic renal cell carcinoma followed by open surgery does not seem to increase the incidence of peritoneal seeding, tract recurrence, or distant metastases. Although the preliminary results are very encouraging, long-term follow-up is clearly necessary.
Santiago
L
L
Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California 91024, USA.
Yamaguchi
R
R
Kaswick
J
J
Bellman
G C
GC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000175:diagnosis* / Q000628:therapy; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged