肝侵襲的轉移性腎細胞癌經部分腎臟切除術後寡尿及尿液囊腫的處理：病例報告

李定廉、張議徽

中國醫藥大學附設醫院 泌尿部

Management of Metastatic Renal Cell Carcinoma with Liver Invasion Complicated by Post partial nepherctomy Oliguria and Urinoma: A Case Report

Ting-Lien Li, Yi-Hui Chang

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Background: This case report presents the clinical course of a 65-year-old male diagnosed with metastatic renal cell carcinoma (RCC) with liver invasion, emphasizing the challenges encountered in managing postoperative complications, including oliguria and suspected urinoma. The objectives are to elucidate the complexities of treating advanced RCC with hepatic involvement and to highlight the multidisciplinary approach adopted in achieving clinical stability.

Case presentation: The patient's medical history, treatment interventions, and postoperative complications were comprehensively reviewed. Following the diagnosis of metastatic RCC with poor-risk factors, the patient underwent a combination of nivolumab and cabozantinib therapy. Subsequently, he underwent right partial nephrectomy and combined right hepatectomy. Postoperatively, oliguria prompted hospital readmissions, during which interventions such as percutaneous abscess drainage (PAD) and dual ureteral stent placement were implemented. Hemodialysis was temporarily halted, and furosemide was initiated for oliguria management. The patient exhibited stable disease following immunotherapy and surgery, as evidenced by a recent follow-up magnetic resonance imaging (MRI). However, oliguria and suspected urinoma with abscess formation necessitated multiple hospital admissions. PAD insertion and dual ureteral stent placement improved drainage, allowing for temporary cessation of hemodialysis. Subsequent interventions, including PAD revision, demonstrated decreased drainage without impacting overall drainage plus urine output. The patient was discharged in a relatively stable condition, having not received hemodialysis since discharge, with furosemide maintaining a daily urine output of approximately 1500ml.

Conclusion: This case underscores the intricate management of metastatic RCC with hepatic invasion, particularly in a patient with pre-existing end-stage renal disease. The successful outcome was achieved through a multidisciplinary approach, incorporating immunotherapy, surgical intervention, and meticulous postoperative care. The report provides valuable insights into navigating challenges associated with complex RCC cases, emphasizing the importance of a comprehensive and collaborative strategy for optimal patient outcomes.