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Laparoscopic partial nephrectomy of thyroid cancer metastasis: case report and review of the literature
Authors Cochetti G, Puxeddu E, Del Zingaro M, D’Amico F, Cottini E, Barillaro F, Mearini E
Received 27 August 2012
Accepted for publication 16 January 2013
Published 10 April 2013 Volume 2013:6 Pages 355—360
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 5
Giovanni Cochetti,1 Efisio Puxeddu,2 Michele Del Zingaro,3 Francesco D’Amico,1 Emanuele Cottini,1 Francesco Barillaro,1 Ettore Mearini1
1Department of General Surgery and Surgical Specialties, Urological Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy; 2Departmentof Internal Medicine, 3Departmentof Surgical Specialties and PublicHealth, Urological Clinic, Universityof Perugia, Perugia, Italy
Background: Follicular cell thyroid carcinoma is a quite aggressive form of thyroid cancer. About 10% of follicular thyroid carcinoma shows multiple metastases: lung and bone are the most common sites of metastasis. Renal involvement from thyroid primary cancer is very rare with incidence of 4.5%–5.9%.
Purpose: We report the first laparoscopic conservative treatment of renal metastasis from thyroid cancer. This is a new and useful approach in order to delay malignant disease progression and to reduce the surgical discomfort of the patient.
Patients and methods: We present the case of a 67-year-old woman, undergoing total thyroidectomy for follicular thyroid cancer with bone and lung metastasis. During adjuvant radiometabolic treatment, renal metastasis was diagnosed. Renal metastasis showed high metabolic activity, reducing the effectiveness of radioiodine therapy for secondary lesions. For this reason, we performed a laparoscopic simple enucleation of the single renal metastasis using extraperitoneal access and a clampless procedure.
Results: The excision of the renal lesion improved the effectiveness of adjuvant radioiodine therapy: two months after surgery, the patient underwent adjuvant radiometabolic treatment with iodine-131 (150 mCi) and the following whole body scan showed only a small uptaking area at the level of the vertebral metastasis. The lung micrometastases were not detectable. At 36 months follow-up, malignant disease was clinically stable and well controlled.
Conclusion: Minimally invasive renal surgery with preservation of renal function and rapid recovery contributed to the success of radioiodine therapy and delayed the progression of the disease.
Keywords: follicular thyroid carcinoma, renal metastasis, simple enucleation, laparoscopy, clampless, radiometabolic treatment
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