title: Potential underdetection of pT(3a) renal-cell carcinoma with laparoscopic morcellation.
abstract: OBJECTIVE
  After tumor morcellation, staging relies on clinical imaging. Our goal was to determine the size distribution of stage pT(3a) renal-cell carcinomas (RCCs) and whether evidence of extrarenal invasion is present on preoperative imaging.
  
  
  METHODS
  We selected patients with organ-confined RCC treated surgically from 1975 to 2002 and subsequently found to have stage pT(3a) disease. Preoperative radiologic imaging reports were reviewed for evidence of extrarenal tumor extension.
  
  
  RESULTS
  Of the 1781 patients treated surgically for pM(0) RCC, 129 (7.2%) had pT(3a) disease. Tumor size distributions were: 17 (13.2%) < or =4 cm, 38 (29.5%) >4 cm but < or =7 cm, and 74 (57.4%) >7cm. There were 6 patients (4.7%) with extrarenal extension according to preoperative imaging. Of these, 2 (5.3%) had tumors >4 cm but < or =7cm, and 4 (5.4%) had tumors >7 cm.
  
  
  CONCLUSIONS
  Many pT(3a) tumors are small, and the majority is understaged clinically. Thus, morcellation in these patients would prevent accurate staging.
authors.affiliation: Department of Urology, Mayo Medical School, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Candace F
authors.initials: CF
authors.lastname: Granberg
authors.forename: Amy E
authors.initials: AE
authors.lastname: Krambeck
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Leibovich
authors.forename: Igor
authors.initials: I
authors.lastname: Frank
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Gettman
authors.forename: Michael L
authors.initials: ML
authors.lastname: Blute
authors.forename: George C
authors.initials: GC
authors.lastname: Chow
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012680:Sensitivity and Specificity