Nephron-sparing surgery for renal angiomyolipoma

Abstract

Objectives: Angiomyolipoma (AML) is a benign renal tumor that may require treatment because of associated local complications. The present study was undertaken to evaluate the efficacy of nephron-sparing surgery (NSS) in the management of renal AML, with respect to the long-term preservation of renal function and absence of tumor recurrence.

Methods: From 1980 to 1997, 27 patients underwent NSS for treatment of renal AML. The clinical presentation, surgical approach, and outcome in these patients were analyzed. Surgical treatment for renal AML was indicated because of associated symptoms, size of 4.5 cm or greater, and/or suspicion of renal malignancy.

Results: In symptomatic patients (52%) the most common presenting signs or symptoms were pain (50%), retroperitoneal hemorrhage or shock (43%), hematuria (36%), hypertension (7%), palpable mass (7%), and anemia (7%). Two patients had tuberous sclerosis. Fifteen patients had a solitary functioning kidney (group I), 6 patients had an impaired contralateral kidney (group II), and 6 patients had a normal contralateral kidney (group III). All operations were performed in situ. There were no operative deaths. All operated kidneys functioned postoperatively, and no patient required dialysis. The mean postoperative serum creatinine level in groups I, II, and III was 1.81, 0.98, and 0.97 mg/dL, respectively. No patients have developed recurrent AML, related symptoms, or required dialysis with follow-up to 177 months (median 39).

Conclusions: When surgical treatment for renal AML is indicated, NSS can be performed with a high success rate even in patients with a very large tumor involving a solitary kidney.