Potential underdetection of pT_3a renal-cell carcinoma with laparoscopic morcellation

Background and Purpose: After tumor morcellation, staging relies on clinical imaging. Our goal was to determine the size distribution of stage pT_3a renal-cell carcinomas (RCCs) and whether evidence of extrarenal invasion is present on preoperative imaging. Patients and Methods: We selected patients with organ-confined RCC treated surgically from 1975 to 2002 and subsequently found to have stage pT_3a disease. Preoperative radiologic imaging reports were reviewed for evidence of extrarenal tumor extension. Results: Of the 1781 patients treated surgically for pM₀ RCC, 129 (7.2%) had pT_3a disease. Tumor size distributions were: 17 (13.2%) ≤4 cm, 38 (29.5%) >4 cm but ≤7 cm, and 74 (57.4%) >7cm. There were 6 patients (4.7%) with extrarenal extension according to preoperative imaging. Of these, 2 (5.3%) had tumors >4 cm but ≤7cm, and 4 (5.4%) had tumors >7 cm. Conclusion: Many pT_3a tumors are small, and the majority is understaged clinically. Thus, morcellation in these patients would prevent accurate staging.