1. Radical vs Partial Nephrectomy for treatment of renal cell carcinoma at Prince Hussein Urology Centre Dr. Mohammad Alserhan Urology specialist Prince Hussein Urology Centre

2. Renal Cell Cancer The 10 th most common tumor in both male & female. Accounts for 3% of all malignancies. The most lethal urological tumor. RCC is primarily a disease of the elderly in the sixth & seventh decades. There is a male predominance with a ratio of 3:2.

3. Objective To overview presentations of patients with R.C.C and to compare between Radical v.s partial nephrectomy as a surgical treatment of R.C.C.

4. Methods & Materials 178 patients who were Diagnosed to have R.C.C at Prince Hussein Urology Centre at King Hussein Medical city from the period of jan.2011 – jul.2014 who underwent Partial or Radical nephrectomy are involved in the study.

5. Presentation Age > 50 years 146 patients ( 82% ) < 50 years 33 patients ( 18% ) » 4 patients < 35 years ( one of them was a female with metastasis )

6. Presentation Gender : Male 142 patients (80%) Females 36 patients (20%) male : female 4:1

7. Presentation

8. TUMORS Tumors Size (pre operative ): < 4 cm 41 patients ( 23%) 4 – 10 cm 100 patients (56 %) >10 cm 37 patients (21 % )

9. TUMORS Exophytic 135 patients (76%) Endophytic 43 patients (24%).Renal vein thrombus 14 patients (8%).I.V.C thrombus 4 patients (2%)

10. Tumors Stage : stage I : T1 N0 M0 5 year survival 95 % stage II : T2 N0 M0 5 year survival 81 % stage III : T3 or N1 M0 5 year survival 60 % stage IV : T4 or M1 5 year survival 20 %

11. Tumors Stage : stage I : 68 patients ( 38 % ) stage II : 87 patients ( 49 % ) stage III : 18 patients ( 10 % ) stage IV : 5 patients ( 3 % ) both stage I & II accounts for about 87 % of cases.

12. Tumors type patients # % clear cell 149 84% papillary 26 14.5% oncocytoma 2 1% sarcoma 1 0.5%

13. Radical vs Partial surgery Radical Partial Patients # (%) 151 ( 85%) 27 ( 15%) average op. time 68 min 92 min avarage tumor size 8,8 cm 3,1 cm major vessle injury ( IVC) 5 patients none Intra op bleeding (Bld Tx ) 3 patients 1 patient adj. organ injury 2 patients none

14. Radical vs Partial surgery Radical Partial surgical approach 147 pt flank incision 4 pt midline incision all pt flank incision post op complications (seroma, wound infection … 15 patients ( 9%) 2 patients ( 7% ) Average hospital stay 3, 8 days 3,5 days

15. Results year Radical Partial 2011 40 4 2012 37 7 2013 48 9 jul 2014 26 7

16. Results All patients underwent surgical treatment within 2 weeks of diagnosis. 6 patients underwent renal artery embolization 18-24 h prior to operation. All patients were F/U according to tumor stage according to AUA protocol. 4 patients received immunotherapy due to their advanced disease.

17. conclusion Radical nephrectomy is still the mostly chosen surgical treatment for RCC in our centre,but nevertheless nephron sparing surgery is increasingly chosen.

18. THANK YOU