Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2024; 12(28): 6187-6194
Published online Oct 6, 2024. doi: 10.12998/wjcc.v12.i28.6187
Incidental renal cell carcinoma post bilateral nephrectomy in autosomal dominant polycystic kidney disease
Min-Ho Shin, Nam-Kyu Choi
Min-Ho Shin, Nam-Kyu Choi, Division of General Surgery, Department of Hepato-Bilio-Pancreatic Surgery and Transplantation Surgery, Chosun University College of Medicine, Gwangju 61453, South Korea
Author contributions: Choi NK contributed to the design and implementation of the study; Shin MH contributed to the analysis of the results and to the writing of the manuscript.
Supported by The Research fund from the Chosun University Hospital, No. 2023-26.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Chosun University Hospital in Gwangju, South Korea (No. 2023-04-009).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors have no conflict-of-interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nam-Kyu Choi, MD, PhD, Professor, Division of General Surgery, Department of Hepato-Bilio-Pancreatic Surgery and Transplantation Surgery, Chosun University College of Medicine, No. 365 Pilmun-daero, Gwangju 61453, South Korea. cnk@chosun.ac.kr
Received: May 24, 2024
Revised: July 1, 2024
Accepted: July 15, 2024
Published online: October 6, 2024
Processing time: 80 Days and 9.2 Hours
Abstract
BACKGROUND

Renal cell carcinoma (RCC) is more common in patients with autosomal dominant polycystic kidney disease (ADPKD) than in the general population. Diagnosing RCC in ADPKD is challenging due to the presence of multiple renal cysts, often leading to delays and difficulties in distinguishing RCC from cyst infection or hemorrhage.

AIM

To analyze the prevalence and characterize the clinical features of RCC in patients with ADPKD undergoing simultaneous bilateral native nephrectomy.

METHODS

Between May 2017 and April 2024, 19 ADPKD patients undergoing hemodialysis and awaiting kidney transplantation due to end-stage renal disease (ESRD) underwent bilateral nephrectomies in a single center. Parameters such as patient characteristics, intraoperative blood loss, blood transfusion volume, length of hospital stay, and postoperative complications were documented. Pathological findings for RCC were reviewed.

RESULTS

A total of 38 kidneys were excised from 19 patients, with a mean age of 56.8 years and an average hemodialysis duration of 84.2 months. Eight patients underwent open nephrectomies, and 11 underwent hand-assisted laparoscopic nephrectomies. RCC was detected in 15.8% of kidneys, affecting 21.1% of patients. Two patients had multifocal RCC in both kidneys. All RCC cases were pT1 stage, with the largest lesion averaging 16.5 mm in diameter. The average operative duration was 120 minutes, with intraoperative blood loss averaging 184.2 mL. Five patients required blood transfusions. Postoperative complications occurred in five patients, with a mean hospital stay of 17.1 days. The mean follow-up period was 28.1 months.

CONCLUSION

The prevalence of RCC is higher in patients with ADPKD with ESRD than in those with ESRD alone. Thus, clinicians should be cautious and implement surveillance programs to monitor the development of RCC in patients with ADPKD, particularly those on dialysis.

Keywords: Renal cell carcinoma; Autosomal dominant polycystic kidney disease; End-stage renal disease; Kidney transplantation; Nephrectomy

Core Tip: Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder that leads to kidney and liver cysts, with a prevalence of 1 in 1000–2500 individuals. It often progresses to end-stage renal disease (ESRD). Incidence of renal cell carcinoma (RCC) is higher in patients with ADPKD than in the general population. Diagnosing RCC in ADPKD is challenging due to overlapping symptoms and distorted renal anatomy. In a study of 19 ADPKD patients undergoing nephrectomy, RCC was found in 21.1% of patients. The study highlights the need for vigilant RCC monitoring in patients with ADPKD, especially those with ESRD.