Introduction Despite the introduction of better diagnostic tools very large kidney tumors are still not so rare in our country. all of the patients treated with radical nephrectomy. Pathological staging was correctly established by imaging studies in all of them. After a few months five of patients (41.6%) required systemic therapy due to lymph node involvement. Conclusions Patients with large kidney tumors should be treated in selected medical centers that have experience in the treatment of such cases. Radical nephrectomy AG-1478 has to be the method of choice in the treatment of patients with this kind of tumor and its diameter should not disqualify from surgical treatment which is still AG-1478 the only chance for the patients to be cured as no adjuvant chemotherapy treatment has proved to be significantly effective. Keywords: kidney tumor nephrectomy RCC upper urinary tract kidney masses INTRODUCTION Epidemiological data has indicated the increase in detection of kidney tumors in recent years [1 2 It is probably bound to an improved option of imaging methods as nearly all tumors are located incidentally without the symptoms. Not surprisingly however a number of the recognized tumors are bigger than 14 cm in size. Remarkably a palpable stomach mass isn’t an alarming sign for some individuals and will not push them to get medical help. Additional symptoms of traditional Virchow triad like flank discomfort and gross hematuria are uncommon not necessarily present [1 2 Paraneoplastic syndromes i.e. pounds reduction hypertension pyrexia or anemia are associated with additional circumstances. Eliminating a big kidney tumor produces a significant concern for an experienced urologist even. The infiltration of adjacent organs existence of neoplasmatic thrombus in vena cava or faraway metastases may be discovered [1 2 3 Many of these raise the perioperative risk. Alternatively only medical procedures when accompanied by administration of TK inhibitors provides patient a opportunity for treatment [4]. Function by Schrader demonstrated that available chemotherapy isn’t effective like a neoadjuvant treatment Mouse monoclonal to FRK found in order to lessen tumor size and stage [5]. The purpose of this study can be to analyze the consequence of medical procedures in individuals with large (≥14 cm) kidney tumor aswell as the perioperative problems based on own encounter and literature. Materials AND Strategies Between springtime 2009 and fall months 2011 12 individuals with kidney tumor ≥14 cm had been operated inside our division. The group contains eight males and four ladies older 46-80 (mean 60). BMI was 21-38 (mean 27). On demonstration five from the 12 individuals (42%) experienced from hematuria weight loss and malaise. The remaining patients were asymptomatic. Lab tests did not reveal abnormal kidney parameters (creatinine levels were <1.3 mg/dl and GFR was >60 ml/min/1.73 m2) nor low hemoglobin concentration (<11 g/dl). When done precisely palpation revealed abdominal mass in all of the patients (6/12 left sided 6 right sided). Kidney tumors were diagnosed by ultrasound (gross hypo-echoic tumor mass blurring normal kidney shape) and confirmed by CT AG-1478 (11/12) or MR (1/12) imaging - gross kidney lesions with heterogenous contrast enhancement (Figs. 1A ? 1 In six of the 12 patients the kidney mass extended into the renal vein. In one patient the kidney cancer thrombus grossly extended into vena cava inferior below the diaphragm. Imaging modalities (CT/MR) indicted periaortic lymph nodes suspicious for metastases in five patients (41.6%). In four patients (33%) the kidney tumor was the only finding. Clinical details are presented in Tab. 1. Figure 1A MRI scan AG-1478 - transverse section of a tumor (diameter - 12 cm). Figure 1B MRI scan - crossection through the tumor (longitudinal length of tumor - 16 cm). Table 1 Clinical details (F - female M - male) Radical nephrectomy including lymphadenectomy and adrenalectomy was performed in all patients due to good performance status facilitating planning of the additional systemic therapy. Transperitoneal medial incision was done in 11 patients (91.6%) and extraperitoneal lumbar AG-1478 approach in one patient (8.4%). Splenectomy was necessary in three cases due to hemorrhage after kidney dissection was completed. (Figs. 2 & 3). Figure 2 Kidney with tumor after excision (Line has a length of 15 cm). Figure 3 Kidney with tumor after excision (Line has a length of 15 cm). RESULTS Mean operation time was 2 h 45’ (2 h 15’ - 4 h) and mean blood loss 700 ml (300-1800 ml). Blood transfusions were.