HISTORY OF RENAL CELL CARCINOMA

1. Renal cell carcinoma
‘The Past’
Dept of Urology
Govt Royapettah Hospital and Kilpauk Medical College
Chennai

2. Moderators:
Professors:
✣ Prof. Dr. G. Sivasankar, M.S., M.Ch.,
✣ Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
✣ Dr. J. Sivabalan, M.S., M.Ch.,
✣ Dr. R. Bhargavi, M.S., M.Ch.,
✣ Dr. S. Raju, M.S., M.Ch.,
✣ Dr. K. Muthurathinam, M.S., M.Ch.,
✣ Dr. D. Tamilselvan, M.S., M.Ch.,
✣ Dr. K. Senthilkumar, M.S., M.Ch.
Dept of Urology, GRH and KMC,
Chennai.
2

3. 3
What were we doing for a 6 cm
partly exophytic renal tumour?

4. 4
The short answer for the question
is:
Radical Nephrectomy (By many)
Partial Nephrectomy (By a few)

5. 5
How did we do?

6. Anatomical Landmarks
6
Dept of Urology, GRH and KMC,
Chennai.

7. Kidney Bridge Position
7
Dept of Urology, GRH and KMC,
Chennai.

8. • Subcostal transperitoneal incision
• Two fingerbreadths below the costal margin from the anterior axillary line to
slightly across the midline.
Anterior Approach
8
Dept of Urology, GRH and KMC,
Chennai.

9. Dept of Urology, GRH and KMC,
Chennai.
Thoraco abdominal Approach
• For large Renal tumours / Upper polar tumours.
• Upper (midline, paramedian or oblique incision) can be easily extended into
either the right or left chest for better exposure.
9

10. Radical Nephrectomy
specimen of an interpole
tumour
10
Dept of Urology, GRH and KMC,
Chennai.

11. 11
When did we do partial
nephrectomy?

12. • Partial nephrectomy is the treatment of choice for T1
tumours.
• If contralateral kidney:
• Stone disease,
• Chronic infection,
• Renovascular disease,
• Vesicoureteral reflux
• Systemic diseases such as hypertension or diabetes
mellitus
Nephron sparing surgery
12
Dept of Urology, GRH and KMC,
Chennai.

13. 13
Partial nephrectomy- Renal
Hypothermia
Dept of Urology, GRH and KMC,
Chennai.

14. Partial nephrectomy
14
Dept of Urology, GRH and KMC,
Chennai.

15. Repair after Partial nephrectomy
15
Dept of Urology, GRH and KMC,
Chennai.

16. 16
But….
The Journey towards the short
answer was
A long one!!!

17. Going back in time….
We meet many pioneers and their ideas!!!
17

18. Daniel Sennert- 1613
“Moreover the hard swelling of the
bad kidneys which has the capacity to
throw a person into cachexia and
dropsy, is for the greater part
incurable.”
18

19. Pierre.F.O.Rayer - 1841
• Treatise on Diseases of the
Kidney
• First illustration of Renal
tumour
19

20. The First illustration
From Rayer PFO, Treatise of the
Diseases of the Kidneys – 1841.
20

21. What is in a Name?
Why the
Renal cell carcinoma
is called as
Renal cell carcinoma?
21

22. Hypernephroma Controversy-1883
Paul Grawitz – Tumours arise from
small ectopic adrenal rests.
22

23. For
• Lubarsh-1894
Coined the term:
Hypernephroid tumour
• Birch-Hirschfeld
Modified to
Hypernephroma
A debate of 14 years
Against
• Sudeck-1893
• Stoerk-1908
• Foot and Humphreys-
Renal celled carcinoma
• Fetter-
Renal cell carcinoma
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24. How to classify?
24

25. Classifications
• WHO 1981 – RCC and others
• Mainz classification-1986, expanded WHO
classification.
25

26. History of Nephrectomy
26

27. Gustav Simon - 1869
• First successful
nephrectomy. 2nd
August 1869.
• Margareta Bleb
• A case of
Ureterovaginal
fistula.
27

28. Sir Thomas Spencer Wells, 1884
• First partial nephrectomy.
• Accidental.
• While performing surgical
removal of a perirenal
fibroadenoma.
28

29. Carl Johan Langenbuch-1875
• British Surgeon.
• First nephrectomy for a patient
of renal tumour.
29

30. Hesitation for the Procedure
• Not commonly performed.
• Wound infection
• Leading to what was called
‘Hospital Gangrene’.
• Mortality was high even
leading upto 40%.
30

31. Mortality Rates of Famous
surgeons 19th century
31

32. 19th Century
(1801-1900)
50
For Renal tumours
300
Total Nephrectomies done
32

33. The End of 19th Century and The
Beginning of 20th Century
The Leap Frog of Medical Science
33

34. Joseph Lister – Carbolic acid
Jan Mikulicz-Radecki- Cotton gloves and Face Mask
William Stewart Halsted – Rubber Gloves
34

35. Karl Landsteiner- ABO blood groups
Richard Lewisohn- Blood Preservation with Citrate
Alexander Flemming- Penicillin
35

36. These technologies led to
the advancement of
complicated surgical procedures.
36

37. Chronologically, which one was done first
for RCC?
Radical Nephrectomy?
Or
Partial Nephrectomy?
37

38. 38
J. Urol 1937;38:15

39. Then, Why did not they continue?
• Doubtful oncological purity,
• Technical drawbacks.
39

40. If so, what were they doing
previously?
40

41. They were doing…
Total simple nephrectomy
41

42. Charles J Robson-1963
• US surgeon
• From Cleveland Clinic.
• Proposed Robson staging
system for RCC.
42

43. • Robson, in 1963, published their 12 years experience of
radical nephrectomy.
• Thoraco abdominal approach with 9th or 10th bed incision.
Diaphragm should be divided.
• Kidney along with the perinephric fat and overlying
peritoneum should be removed.
43

44. 1970s- Renewed Interest
• Eugene F Poutasse- Selective vascularization of kidney
• Kerr and Klotz- Renal hypothermia
44

45. J. Urol 1993;149:1-7
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46. Litch and Novick - Analysis
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47. • Incidentally discovered, 3 cm or less
• May be performed for peripheral and central masses."
• Even tumors greater than 5 cm may be excised
completely if they are favorably located within the
kidney.
47 J. Urol 1999;161:33-35

48. 48 J. Urol 2000;163:442-445

49. Thank You
49