Chromophobe renal-cell carcinoma during pregnancy: A robot-assisted laparoscopic partial nephrectomy (Da Vinci) at 32+0 gestational weeks

Objective:

The incidence and evidence for treatment modalities of renal-cell carcinoma (RCC) during pregnancy are low. This is why we want to present a case of a robot-assisted laparoscopic partial nephrectomy in a 37-years-old woman with a renal mass at her 31st gestational week.

Material and methods:

She was admitted to our clinic after a monoclonal gammopathy Typ I IgG kappa and microscopic hematuria was incidentally diagnosed. During routine antenatal ultrasonography a tumor of 6.5 cm × 6.8 cm, located in the bottom half of the right kidney, was detected. MRI demonstrated the solid-enhancing renal mass concerning for malignancy, without evidence of local extension or metastases. The literature was reviewed via Pubmed. A multidisciplinary approach was undertaken perioperatively. At 32+0 gestational weeks a robot-assisted laparoscopic partial nephrectomy was performed. Fetal heart rate was monitored during treatment. Total operating time was 153 minutes, 1000 ml blood transfusion was admitted. Warm ischemia time was 15 minutes. The patient's creatinine peaked at 0.66 mg/dL and her hemoglobin nadir reached 10.1 g/dL. She was discharged on postoperative day 7 in excellent condition. Final pathology demonstrated a 6.4 cm chromophobe RCC with negative margins. The postoperative course was uneventful. At 40+6 gestational weeks a healthy infant was born by cesarean section for other indication.

Conclusion:

Nephronsparing surgeries during pregnancy are feasible but requires perioperative planning, multidisciplinary coordination, and careful operative decision-making to ensure optimal safety of mother and fetus. To our knowledge the first case of robot-assisted laparoscopic partial nephrectomy in third trimester pregnancy is reported.