Initial Biopsy

Initial tumor biopsy is extremely important in determining biologic aggressiveness, as discussed previously. The surgeon should obtain at least 1 cm3 of viable tumor tissue, or more if possible. Often the mass is enclosed by a pseudocapsule which can be exploited for hemostasis. The capsule is opened and multiple biopsies are taken. Hemostatic agents can then be used to pack the capsule. Central line placement and staging bone marrow aspirations and biopsies can be conveniently done at the same time.

Table 11.4.4 Complication rates

Reference

Number

Complication rate (%)

Nephrectomies/ renal infarction (n)

Operative mortality

Shamberger et al. (1991)

0 0

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