Virtual Tumor Board
Facillicating communitcaion and collaboration relating to kidney cancers
What is the Virtual Tumor Board?
The VTB is a collaborative forum for urologists to ask questions and provide insight or context into complex or nuanced kidney cancer cases.
The goal of the VTB is to provide peer input on difficult renal mass cases to improve treatment outcomes and appropriateness.
Sample VTB Case:
- 51 years old
- History of obesity, hypertension, and DM
- Presented with left flank pain
- GFR 80
- No hematuria
- Large 8.7 x 10.6 cm exophytic hemorrhagic cystic renal mass on the left
- Contralateral atrophic kidney
- R=3 E=2 N=2 L=2
Biopsy showed blood and necrosis and focal concern for renal cell carcinoma, clear cell.
Mass still 9 x 9 cm, mostly exophytic, anterior, and looks like it has a nice capsule around it.
We opted for short interval (8-week) re-imaging to assess improvement and characterization.
Scan showed improvement, mass still 9x9cm, mostly exophytic, anterior, and has a nice capsule around it
The patient is understandably anxious and wants this taken care of ASAP
urologists supported partial nephrectomy
5 urologists supported robotic
1 urologist supported open
"Tough case. Thanks for sharing. I would probably go open on ice given that stakes are higher. Although a robotic approach might facilitate fine dissection along renal vein into sinus plane, eventually would need to "trap door" the tumor away and there would be more pressure on the deep portion of the cyst while enucleating the base, with possible increased risk of rupture. Dissection will be hard either way. Likely to be stuck. Despite obesity, perinephric fat doesn't look that bad for open. I like that all are in favor of kidney sparing for this imperative partial."