Staged minimally invasive treatment of inflammatory abdominal aortic aneurysm and renal cell carcinoma.
BACKGROUND
Laparoscopic radical nephrectomy has become an international standard of care for medium to large renal tumors. Endovascular aneurysm repair (EVAR) has been accepted as a reasonable alternative to open abdominal aortic aneurysm (AAA) repair. We report a case of minimally invasive management of two potentially lethal diseases in a single hospitalization.


METHODS
The patient is a 76-year-old male who was found to have an incidental finding of an AAA and an enhancing 9 cm left central renal mass. He was deemed to be an appropriate candidate for endovascular AAA repair and laparoscopic nephrectomy based on preoperative imaging. Secondary to mild, chronic renal insufficiency, a staged approach was planned: EVAR followed by nephrectomy.


RESULTS
Successful minimally invasive treatments of the AAA and renal mass were accomplished in a staged fashion within 48 hours. The patient underwent successful EVAR for his inflammatory aneurysm and was admitted after the procedure for hydration and renal function monitoring. Two days later, a successful laparoscopic radical nephrectomy was performed. The patient was discharged postnephrectomy day 3 and hospital day 5. Pathology revealed a T2NxMx conventional renal cell carcinoma (RCC). He has been continuously followed for 4 years postoperatively with no evidence of cancer recurrence and a shrinking aneurysm sac without leak.


CONCLUSIONS
We present a case of two potentially lethal disease processes previously handled in an open surgical fashion just a few short years ago. A combination of minimally invasive approaches in a staged fashion allowed a prompt patient recovery with no significant postoperative morbidity. To our knowledge, this represents the first case report of a staged minimally invasive treatment of synchronous vascular and renal pathology.
Pattaras
John G
JG
Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.
Milner
Ross
R
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002292:Carcinoma, Renal Cell / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D033162:Incidental Findings; D007680:Kidney Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D014057:Tomography, X-Ray Computed