J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website http://www.jcgo.org

Case Report

Volume 5, Number 3, September 2016, pages 92-96

Combined Surgery for Uterine and Renal Cell Cancers in Obese Patients: A Case Series

Figure 1. A preoperative CT scan of the abdomen reveals an enlarged, irregular uterus with multiple calcifications as well as an exophytic, heterogeneous mass extending from the inferior pole of the right kidney.

**Table 1.** Review of Cases With Synchronous Uterine and Renal Tumors, Patient Characteristics, Surgical Management, and Pathology
Case	Age^a	BMI (kg/m²)	Surgery	Uterine pathology	Renal pathology
^aAge at diagnosis. ^bEndometrioid histology unless otherwise specified. ^cStaging assigned by the joint 2010 version of the International Federation of Gynecology and Obstetrics (FIGO)/Tumor, Nodes, Metastasis (TNM) classification system for uterine carcinoma. ^dStaging assigned by the 2010 version of the tumor, nodes, metastasis (TNM) classification system for kidney cancer. BMI: body mass index; RaTLH: robotic-assisted total laparoscopic hysterectomy; BSO: bilateral salpingo-oophorectomy; TAH: total abdominal hysterectomy; PPLND: pelvic and para-aortic lymph node dissection.
1	53	61	RaTLH, BSO + hand-assisted laparoscopic R radical nephrectomy	G1	II	Clear cell, grade 3	T2aNX
2	71	49	TAH, BSO, PPLND + open R radical nephrectomy	G1	IA	Clear cell, grade 2	T2aN0
3	74	32	TAH, BSO, omentectomy, splenectomy + open L nephrectomy, adrenalectomy	Carcinosarcoma	IVB	Papillary, type II, grade 3	T2aNX
4	71	39	TAH, BSO, PPLND, omentectomy, splenectomy + open L radical nephrectomy, adrenalectomy	Papillary serous carcinoma	IVB	Papillary, type II, grade 3	T1aN0
5	70	38	TAH, BSO, PPLND, omentectomy + open L partial nephrectomy	Carcinosarcoma	IA	Clear cell, grade 2	T1aN0
6	46	45	TAH, BSO, PPLND + open R nephrectomy	G1	IA	Clear cell, grade 2	T1bN0

Table 1. Review of Cases With Synchronous Uterine and Renal Tumors, Patient Characteristics, Surgical Management, and Pathology

Case

Age^a

BMI (kg/m²)

Surgery

Uterine pathology

Renal pathology

Histology^b

Stage^c

Histology

Stage^d

^aAge at diagnosis. ^bEndometrioid histology unless otherwise specified. ^cStaging assigned by the joint 2010 version of the International Federation of Gynecology and Obstetrics (FIGO)/Tumor, Nodes, Metastasis (TNM) classification system for uterine carcinoma. ^dStaging assigned by the 2010 version of the tumor, nodes, metastasis (TNM) classification system for kidney cancer. BMI: body mass index; RaTLH: robotic-assisted total laparoscopic hysterectomy; BSO: bilateral salpingo-oophorectomy; TAH: total abdominal hysterectomy; PPLND: pelvic and para-aortic lymph node dissection.

RaTLH, BSO + hand-assisted laparoscopic R radical nephrectomy

Clear cell, grade 3

T2aNX

TAH, BSO, PPLND + open R radical nephrectomy

Clear cell, grade 2

T2aN0

TAH, BSO, omentectomy, splenectomy + open L nephrectomy, adrenalectomy

Carcinosarcoma

IVB

Papillary, type II, grade 3

T2aNX

TAH, BSO, PPLND, omentectomy, splenectomy + open L radical nephrectomy, adrenalectomy

Papillary serous carcinoma

IVB

Papillary, type II, grade 3

T1aN0

TAH, BSO, PPLND, omentectomy + open L partial nephrectomy

Carcinosarcoma

Clear cell, grade 2

T1aN0

TAH, BSO, PPLND + open R nephrectomy

Clear cell, grade 2

T1bN0

**Table 2.** Review of Cases With Synchronous Uterine and Renal Tumors, Perioperative Outcomes and Disease Status
Case	Operative time, min	EBL, mL	Blood products^a	Length of hospitalization, days	Operative complication	Disease status
^aTotal blood products transfused during hospitalization. EBL: estimated blood loss; NED: no evidence of disease; PRBCs: packed red blood cells; FFP: fresh frozen plasma; PCC: prothrombin complex concentrate.
1	412	200	None	7	None	NED 32 months from diagnosis
2	308	1,000	27 units PRBCs, 17 units FFP, 9 units platelets, 5 units cryoprecipitate, 1 unit PCC	4	Postoperative bleeding, liver laceration	N/A; died on postoperative day 3
3	291	2,000	4 units PRBCs	5	Cystotomy, splenectomy	Deceased, presumptively from uterine carcinosarcoma, approx. 4 months from diagnosis
4	297	2,275	3 units PRBCs	6	Splenectomy	Alive with recurrent endometrial cancer with intracranial metastatic disease; recently completed palliative whole brain radiation
5	379	1,000	1 unit PRBCs	6	None	NED 19 months from diagnosis
6	236	2,600	5 units PRBCs	8	None	Records unavailable

Table 2. Review of Cases With Synchronous Uterine and Renal Tumors, Perioperative Outcomes and Disease Status

Case

Operative time, min

EBL, mL

Blood products^a

Length of hospitalization, days

Operative complication

Disease status

^aTotal blood products transfused during hospitalization. EBL: estimated blood loss; NED: no evidence of disease; PRBCs: packed red blood cells; FFP: fresh frozen plasma; PCC: prothrombin complex concentrate.

412

200

None

NED 32 months from diagnosis

308

1,000

27 units PRBCs, 17 units FFP, 9 units platelets, 5 units cryoprecipitate, 1 unit PCC

Postoperative bleeding, liver laceration

N/A; died on postoperative day 3

291

2,000

4 units PRBCs

Cystotomy, splenectomy

Deceased, presumptively from uterine carcinosarcoma, approx. 4 months from diagnosis

297

2,275

3 units PRBCs

Splenectomy

Alive with recurrent endometrial cancer with intracranial metastatic disease; recently completed palliative whole brain radiation

379

1,000

1 unit PRBCs

None

NED 19 months from diagnosis

236

2,600

5 units PRBCs

None

Records unavailable