High-risk early-stage clear cell renal carcinoma treated with Hugo™ ras-assisted partial nephrectomy: a case report

Authors

DOI:

https://doi.org/10.48193/gnnhe441

Keywords:

Clear cell renal cell carcinoma; , Partial nephrectomy; , Robotic surgery;, Hugo™ RAS; , Tumor necrosis; , Vascular invasion;, Immunohistochemistry.

Abstract

Background: Clear cell renal cell carcinoma (ccRCC) is the most common malignant renal neoplasm and exhibits heterogeneous biological behavior. Prognosis is influenced by histopathological factors such as nuclear grade, tumor necrosis, and vascular invasion, even in small tumors. The development of robotic platforms such as the Hugo™ RAS system has expanded the role of nephron-sparing surgery.

Case presentation: We report a 42-year-old male with an incidentally detected left renal mass measuring approximately 4 cm, with solid-cystic features with a 5p R.E.N.A.L Score. The patient underwent Hugo™ RAS-assisted partial nephrectomy without intraoperative complications. Histopathological evaluation revealed clear cell renal cell carcinoma, WHO/ISUP grade 3, with 30 % tumor necrosis and vascular invasion, confined to the kidney, with negative surgical margins (pT1a). Immunohistochemical analysis showed positivity for CAIX and negativity for CK7, TFE3, and ALK, supporting the diagnosis.

Discussion: Despite its early stage, the presence of tumor necrosis, high nuclear grade, and vascular invasion suggests a potentially aggressive biological behavior. This case highlights the importance of integrating histopathological findings with advances in robotic surgery to achieve accurate prognostic stratification and optimize clinical management.

Author Biography

  • Víctor Enrique Corona-Montes, Secretaría de Salud, Hospital General de México “Dr. Eduardo Liceaga”, Ciudad de México, México.

    Dr. Víctor Enrique Corona Montes is a passionate surgeon specialized in oncological urology. Expert in diagnosis and treatments with minimally invasive surgery for prostate cancer, kidney cancer, bladder cancer and other urological conditions.

    He obtained the title of Doctor (UMSNH) and immediately completed a specialization in Urological Surgery (UNAM). In 2011, he travels to France to learn from the best Master in the field of minimally invasive urological surgery, Professor Richard Gaston, in Bordeaux, France. Dr. Corona performed around 800 robotic surgeries with his Master Gastón and returned to Mexico to open the first Robotic Surgery program in Mexico City in 2013 with a radical robot-assisted prostatectomy 8 years ago in Mexico.

    In 2015, he completed a second clinical fellowship in Oncological Urology (High Specialty) at the Fundació Puigvert in Barcelona, ​​Spain, this time under the tutelage of Professor Joan Palou Redorta, current director of the Fundació Puigvert.

    Currently, Dr. Corona is Deputy Director of Diangostic and Treatment  at the General Hospital of Mexico "Dr. Eduardo Liceaga". Founder and Head of the High Specialty Program in Laparoscopic and Robotic Surgery in Urology for UNAM (National Autonomous University of Mexico) and for Mexico, as well as member of the Academic Committee of Urology, of the same University.

    Ex-Coordinator of the Laparoscopy and Endourology Section of the Mexican Society of Urology (S.M.U.) between 2013-2016 and Ex- Coordinator of Urological Tumors of the Mexican Society of Oncology for the 2017-2019 cycle (SMeO)

    Author of numerous national and international scientific publications (articles, book chapters), as well as lecturer, trainer (IRCAD France and Brazil), speaker at the international level. He is constantly updated after taking Oncology courses at the Universities of Tampa and Chicago, as well as an active participant in the Oncology Urology Symposia at Mont Sinai Hospital in New York.

    In addition to sharing experiences with their students and their classmates. He has 4 master's degrees, one in Administration of Health Institutions, (U. Anáhuac), one in History of Medicine from the Descartes University of Paris, Master's in Education from the Tecnológica University and Master´´ s in Public Administration (INAP). He also has a specialty in Corporate Health and Wellness (U. Anáhuac) and a Doctorate in Senior Management (CEPEM).

    He is fluent in 5 languages ​​and is currently studying one more.

References

Hsieh JJ, Purdue MP, Signoretti S, Swanton C, Albiges L, Schmidinger M, et al. Renal cell carcinoma. Nature Reviews. Disease Primers. 2017;3: 17009. https://doi.org/10.1038/nrdp.2017.9.

Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. European Urology. 2016;70(1): 93–105. https://doi.org/10.1016/j.eururo.2016.02.029.

Kaelin WG. The von Hippel-Lindau tumour suppressor protein: O2 sensing and cancer. Nature Reviews. Cancer. 2008;8(11): 865–873. https://doi.org/10.1038/nrc2502.

Linehan WM, Ricketts CJ. The metabolic basis of kidney cancer. Seminars in Cancer Biology. 2013;23(1): 46–55. https://doi.org/10.1016/j.semcancer.2012.06.002.

Williamson SR, Taneja K, Cheng L. Renal cell carcinoma staging: pitfalls, challenges, and updates. Histopathology. 2019;74(1): 18–30. https://doi.org/10.1111/his.13743.

Delahunt B, Cheville JC, Martignoni G, Humphrey PA, Magi-Galluzzi C, McKenney J, et al. The International Society of Urological Pathology (ISUP) Grading System for Renal Cell Carcinoma and Other Prognostic Parameters. American Journal of Surgical Pathology. 2013;37(10): 1490–1504. https://doi.org/10.1097/PAS.0b013e318299f0fb.

Hu Z, Zhou Y, Xie L, Zhang S, Liu Y, Zhang W, et al. Identification and Validation of a Prognostic Model Based on Tumour Necrosis Factor‐Related MRNAS for Kidney Renal Clear Cell Carcinoma. Journal of Cellular and Molecular Medicine. 2025;29(14): e70657. https://doi.org/10.1111/jcmm.70657.

Ljungberg B, Albiges L, Abu-Ghanem Y, Bedke J, Capitanio U, Dabestani S, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 Update. European Urology. 2022;82(4): 399–410. https://doi.org/10.1016/j.eururo.2022.03.006.

Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. The Journal of Urology. 2009;182(3): 844–853. https://doi.org/10.1016/j.juro.2009.05.035.

Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A, et al. Renal Mass and Localized Renal Cancer: AUA Guideline. Journal of Urology. 2017;198(3): 520–529. https://doi.org/10.1016/j.juro.2017.04.100.

Kunath F, Schmidt S, Krabbe LM, Miernik A, Dahm P, Cleves A, et al. Partial nephrectomy versus radical nephrectomy for clinical localised renal masses. Cochrane Urology Group (ed.) Cochrane Database of Systematic Reviews. 2017;2017(5). https://doi.org/10.1002/14651858.CD012045.pub2.

Kubota M, Yamasaki T, Murata S, Abe Y, Tohi Y, Mine Y, et al. Surgical and functional outcomes of robot-assisted versus laparoscopic partial nephrectomy with cortical renorrhaphy omission. Scientific Reports. 2022;12(1): 13000. https://doi.org/10.1038/s41598-022-17496-2.

Gallioli A, Uleri A, Gaya JM, Territo A, Aumatell J, Verri P, et al. Initial experience of robot-assisted partial nephrectomy with HugoTM RAS system: implications for surgical setting. World Journal of Urology. 2023;41(4): 1085–1091. https://doi.org/10.1007/s00345-023-04336-9.

Prata F, Raso G, Ragusa A, Iannuzzi A, Tedesco F, Cacciatore L, et al. Robot-Assisted Renal Surgery with the New Hugo Ras System: Trocar Placement and Docking Settings. Journal of Personalized Medicine. 2023;13(9): 1372. https://doi.org/10.3390/jpm13091372.

Prata F, Basile S, Tedesco F, Ragusa A, Iannuzzi A, De Giuseppe A, et al. Robot-assisted partial nephrectomy with the HugoTM RAS system: Perioperative outcomes from a single-center cohort including moderate-to-highly complex renal masses. Urologic Oncology. 2025;43(12): 706.e27-706.e33. https://doi.org/10.1016/j.urolonc.2025.07.023.

Prata F, Ragusa A, Tedesco F, Pira M, Iannuzzi A, Fantozzi M, et al. Trifecta Outcomes of Robot-Assisted Partial Nephrectomy Using the New HugoTM RAS System Versus Laparoscopic Partial Nephrectomy. Journal of Clinical Medicine. 2024;13(7): 2138. https://doi.org/10.3390/jcm13072138.

Prata F, Iannuzzi A, Tedesco F, Ragusa A, Civitella A, Pira M, et al. Surgical Outcomes of HugoTM RAS Robot-Assisted Partial Nephrectomy for Cystic Renal Masses: Technique and Initial Experience. Journal of Clinical Medicine. 2024;13(12): 3595. https://doi.org/10.3390/jcm13123595.

Golovastova MO, Korolev DO, Tsoy LV, Varshavsky VA, Xu WH, Vinarov AZ, et al. Biomarkers of Renal Tumors: the Current State and Clinical Perspectives. Current Urology Reports. 2017;18(1): 3. https://doi.org/10.1007/s11934-017-0655-1.

García Rojo E, Hevia Palacios V, Brime Menendez R, Feltes Ochoa JA, Justo Quintas J, Lista Mateos F, et al. Da Vinci and Hugo RAS Platforms for robot-assisted partial nephrectomy: a preliminary prospective comparative analysis of the outcomes. Minerva Urology and Nephrology. 2024;76(3): 303–311. https://doi.org/10.23736/S2724-6051.24.05623-4.

Prata F, Basile S, Tedesco F, Ragusa A, Pira M, Iannuzzi A, et al. Skill Transfer from Laparoscopic Partial Nephrectomy to the HugoTM RAS System: A Novel Proficiency Score to Assess Surgical Quality during the Learning Curve. Journal of Clinical Medicine. 2024;13(8): 2226. https://doi.org/10.3390/jcm13082226.

Solairaj D, Tyagi V, Tyagi A, Agarwal B. Factors influencing trifecta outcomes following robot-assisted partial nephrectomy for stage I renal cell carcinoma using the HugoTM RAS system: a prospective observational study and comparison with contemporary literature. Journal of Robotic Surgery. 2025;20(1): 71. https://doi.org/10.1007/s11701-025-03037-2.

Toubasey S, Tehrani MS, Shepherd A, Beetge N, Thakur A, Muralitharan M, et al. A systematic review of global experiences with Medtronic’s HugoTM robotic system for robot-assisted partial nephrectomy. Journal of Robotic Surgery. 2025;19(1): 654. https://doi.org/10.1007/s11701-025-02818-z.

Prata F, Dell’Oglio P, Mottaran A, Bertolo R, Tappero S, Piazza P, et al. Robot-assisted partial nephrectomy using the HugoTM RAS System: first multicentre study and Tetrafecta achievement. BJU International. 2025;136(6): 1145–1155. https://doi.org/10.1111/bju.70009.

Bobrowski A, Wu W, Angeles C, Czajkowski S, Lee JY. Robotic-assisted partial nephrectomy using the HugoTM robotic-assisted surgery platform. Canadian Urological Association Journal. 2025;19(4): 110–115. https://doi.org/10.5489/cuaj.8951.

Gill AJ. Succinate dehydrogenase (SDH)-deficient neoplasia. Histopathology. 2018;72(1): 106–116. https://doi.org/10.1111/his.13277.

Bavikar R, Patel P, Verma A, Ingale Y, Randive R. Heterotopic bone formation in a case of clear cell renal cell carcinoma: A case report. Journal of Cancer Research and Therapeutics. 2024;20(1): 482–484. https://doi.org/10.4103/jcrt.jcrt_2085_22.

Mier JW. The tumor microenvironment in renal cell cancer. Current Opinion in Oncology. 2019;31(3): 194–199. https://doi.org/10.1097/CCO.0000000000000512.

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Published

2026-08-27

Issue

Vol. 86 No. 4 (2026): July-August

Section

Clinical cases

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