Localized chromophobe renal cell carcinoma: preoperative imaging judgment and laparoscopic simple enucleation for treatment

ABSTRACT Objective: To evaluate the preoperative imaging manifestation and therapeutic effect of laparoscopic simple enucleation (SE) for localized chromophobe renal cell carcinoma (chRCC). Materials and Methods: Clinical data of 36 patients who underwent laparoscopic SE of localized chRCC at our institute were retrospectively analyzed. All patients underwent preoperative renal protocol CT (unenhanced, arterial, venous, and delayed images). CT scan characteristics were evaluated. After intraoperative occlusion of the renal artery, the tumor was free bluntly along the pseudocapsule and enucleated totally. The patients were followed up regularly after the operation. Results: Mean tumor diameter was 3.9±1.0 cm, 80% of tumors were homogeneous and all the tumors had complete pseudocapsule. The attenuation values were slightly lower than normal renal cortex and degree of enhancement of the tumors were significantly lower than normal renal cortex. Mean operation time was 104.3±18.2 min. Mean warm ischemia time (WIT) was 21.3±3.5 min. Mean blood loss was 78.6±25.4 mL. No positive surgical margin was identified. Mean postoperative hospital stay was 5.3±1.5 d. Hematuria occurred in 3 patients and all disappeared within 3 days. After a mean follow-up of 32.1±20.6 months, no patient had local recurrence or metastatic progression. Conclusion: Localized chRCCs have a great propensity for homogeneity and complete pseudocapsule. The attenuation values were slightly lower than normal renal cortex and small degree of enhancement. Laparoscopic SE is a safe and effective treatment for localized chRCC. The oncological results were satisfactory.

摘要
目的：评估腹腔镜单纯剜除术（laparoscopic simple enucleation, SE）治疗局限性嫌色细胞肾细胞癌（chromophobe renal cell carcinoma, chRCC）的术前影像学表现与临床治疗效果。
材料与方法：回顾性分析本院36例接受局限性chRCC腹腔镜SE治疗患者的临床资料。所有患者术前均行肾脏专用CT扫描（包含平扫、动脉期、静脉期及延迟期图像），并对CT影像特征进行评估。术中阻断肾动脉后，沿肿瘤假包膜钝性游离肿瘤并完整剜除。术后对患者进行定期随访。
结果：患者肿瘤平均直径为3.9±1.0 cm，80%的肿瘤呈均匀密度，所有肿瘤均具有完整假包膜。肿瘤的CT衰减值略低于正常肾皮质，且强化程度显著低于正常肾皮质。手术平均时长为104.3±18.2 min，热缺血时间（warm ischemia time, WIT）平均为21.3±3.5 min，平均失血量为78.6±25.4 mL。未发现手术切缘阳性病例。术后平均住院时长为5.3±1.5 d，3例患者出现血尿症状，均在3日内自行消失。平均随访时长为32.1±20.6个月，所有患者均未出现局部复发或远处转移。
结论：局限性chRCC多表现为均匀密度且伴完整假包膜，其CT衰减值略低于正常肾皮质，强化程度较低。腹腔镜SE治疗局限性chRCC安全有效，肿瘤学结局令人满意。