單一遠端恥骨轉移之腎臟細胞癌行轉移病灶切除手術之案例分享
張家程、裘坤元
臺中榮民總醫院外科部泌尿科
Metastectomy of renal cell carcinoma pubic bone lesion—case reprt
ChangChiaCheng, ChiuKunYuan
Taichung Veteran General Hospital, Department of Surgery, Division of Urology
Purpose: During the new era of advance in systemic treatment, the treatment policy for patients with metastatic renal cell carcinoma had changed. If resection of the metastatic lesion seemed applicable, patients may benefit from metastectomy. We present a case of distal recurrence clear cell RCC over pubic bone who received bone lesion metastectomy and pelvic bone reconstruction.
Materials and Methods: This 75 years old man was diagnosed with left kidney renal tumor with initial symptoms of gross hematuria 8 years ago. He received laparoscopic nephrectomy then with pathologic result of left kidney clear cell RCC, pT1a. During the following up, he behaved well in such a disease-free condition.
However, he complained left hip pain and gradually impaired walking function. He returned the GU OPD with kidney CT revealed left pubic bone destructive bone lesion. The biopsy revealed distal metastesis with clear cell carcinoma. Further combined surgery was arranged with urologist, orthologist and possible reconstruction with plastic surgeon.
Results: He received tumor excision and bone reconstruction. Plastic surgeon made the ALT free flap plan first. Tumor site was widely explored with finding of left pubic bone and left acetabular joint involvement. En bloc tumor wide excision from right pubic bone to left acetabular joint, left quadriceps muscle with obturator nerve and left levator-ani muscle as safe margin. Pubic bone reconstruction with bone graft and plate was done. The fascia and skin tension was in acceptable range with direct closure and there was no need for free flap reconstruction. The total operative time was 11 hours and 35 minutes. The total blood loss was 4800ml. The patient started trying water on the post-operative day 3. He started weight bearing on the post-op day 4. The total hospital course was 14 days.
Conclusion: Metastectomy of bone lesion was applicable under the purpose that patient may benefit from the cyto-reductive surgery. Even over the tough bone lesion site, the patient could tolerate the whole course smoothly under well-planned combined surgery. Further target therapy or immunotherapy would be prescribed and we will follow up the long-term outcome for this patient.