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Approach to the Management of Large and Advanced Renal Tumors

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Diagnosis and Surgical Management of Renal Tumors

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Abstract

The safe and efficacious surgical management of large and advanced renal tumors begins with careful preoperative evaluation and planning. The choice of surgical exposure and approach must be tailored to the tumor size, location, and relevant patient anatomy. Radical nephrectomy should be performed while respecting normal anatomic relationships, even where there is distortion by the tumor. The management of an associated venous thrombus depends on its level. Such cases should be approached as a predominantly vascular procedure, with renal artery control first, venous tumor thrombectomy second, and radical nephrectomy third. Renal cancers invading adjacent structures can be resected en bloc if needed. Although surgery for nonmetastatic advanced renal cancers carries a nontrivial risk of morbidity and mortality, satisfactory oncologic outcomes can be achieved with a thoughtful surgical approach.

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Authors and Affiliations

  1. Department of Urology, Mayo Clinic, Rochester, MN, USA

    Bimal Bhindi & Bradley C. Leibovich

  2. Southern Alberta Institute of Urology, Calgary, Alberta, Canada

    Bimal Bhindi

Authors
  1. Bimal Bhindi
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  2. Bradley C. Leibovich
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Correspondence to Bradley C. Leibovich .

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Editors and Affiliations

  1. The James Buchanan Brady Urological, Institute and Department of Urology, Johns Hopkins University School of Medic, Baltimore, MD, USA

    Michael A. Gorin

  2. The James Buchanan Brady Urological, Institute and Department of Urology, Johns Hopkins University School of Medic, Baltimore, MD, USA

    Mohamad E. Allaf

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Bhindi, B., Leibovich, B.C. (2019). Approach to the Management of Large and Advanced Renal Tumors. In: Gorin, M., Allaf, M. (eds) Diagnosis and Surgical Management of Renal Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-92309-3_9

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  • DOI: https://doi.org/10.1007/978-3-319-92309-3_9

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