Preview

Онкоурология

Расширенный поиск

Роль органосохраняющего хирургического лечения рака почки на современном этапе

https://doi.org/10.17650/1726-9776-2007-0-2-5-11

Полный текст:

Аннотация

Objective: to assess the results of organ-preserving treatment of patients with renal cell carcinoma (RCC).

Materials and methods: 238 patients with renal tumors underwent partial nephrectomy at our institution between 1971 and 2006. 35(14.7%) of 238 patients were showed to have benign histology. RCC was revealed in 203(85.3%) cases on pathological examination. The latter group was retrospectively analyzed.

Results: The indications for partial nephrectomy included bilateral lesions in 28.6%, solitary kidney in 3.9%, solitary functioning kidney in 1.5%, horseshoe kidney in 4.9%. An elective partial nephrectomy was performed in 61.1% of the patients. Local stage T was considered as T1 in 68.7%, T2 Р in 24.2%, T3а Р in 6.6%, T3в Р in 0.5% cases. Among 58 patients with bilateral lesions T stage of the contralateral kidney was considered as T1 in 25.9%, T2 Р in 10.3%, T3а Р in 12.0%, T3b Р in 3.5%, Tх Р in 48.3% cases. Positive lymph nodes (N+) were found in 2 (1.5%), distant metastases (M1) in 5 (2,5%) patients. An open partial nephrectomy was performed in 92.1%, laparoscopic in 2.5%, bench surgery in 4.4% cases. In 82.2% cases of bilateral RCC the surgery was performed on both kidneys. Five (2.5%) patients with solitary metastasis were treated with liver resection (1), pulmonary resection (1), scapular resection (1), contralateral adrenalectomy(2). Early surgical complications which required surgery occurred in 6.9% cases. Acute renal failure that necessitates dialysis was registered in 3.9%, chronic renal insufficiency with programmed dialysis in 1.0% of the patients. Renal artery clamping for more than 30 minutes significantly increased the risk of renal failure. Local recurrences appeared in 8.9% (local in 2.5%, distant in 6.4%) patients at a median of 56.1(3—120) months following surgery. The width of the surgical margin has no impact on local recurrence rate. 5-year cancer-specific and relapse-free survival of the whole group of patients was 93.4% and 82.5%, respectively; in the subgroups of uniand bilateral lesion, these were 95.1% and 89.6%, and 91.5% and 75.2%, respectively (p>0,05). T stage and presence of positive lymph nodes and distant metastases significantly influenced the survival.

Conclusion: partial nephrectomy in patients with RCC has a low complication rate and provides an excellent long term survival in patients with localized disease.

Об авторах

В. Б. Матвеев
Отделение урологии РОНЦ им. Н.Н. Блохина РАМН
Россия
Москва


Б. П. Матвеев
Отделение урологии РОНЦ им. Н.Н. Блохина РАМН
Россия
Москва


М. И. Волкова
Отделение урологии РОНЦ им. Н.Н. Блохина РАМН
Россия
Москва


Д. В. Перлин
Отделение трансплантации почки НИИ урологии
Россия
Москва


К. М. Фигурин
Отделение урологии РОНЦ им. Н.Н. Блохина РАМН
Россия
Москва


Список литературы

1. Moinzadeh A., Gill A.M., Finelli A. et al. Laparoscopic partial nephrectomy: 3-year followup. J Urol 2006;175:459—62.

2. Lau W.K., Blute M.L., Weaver A.L. et al. Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 2000;75(12):1236—42.

3. Clark P.E., Schover L.R., Uzzo R.G. et al. Quality of life and psychological adaptation after surgical treatment for localized renal cell carcinoma: impact of the amount of remaining renal tissue. Urology 2001;57(2):252—6.

4. Uzzo R.G., Novick A.C. Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 2001;166(1):6—18.

5. Аляев Ю.Г., Крапивин А.А. Резекция почки при раке. М., Медицина; 2001. с. 42—51.

6. Van Poppel H., Da Pozzo L., Albrecht W. et al. Prospective Randomized EORTC Intergroup Phase 3 Study Comparing the Complications of Elective Nephron-Sparing Surgery and Radical Nephrectomy for Low-Stage Renal Cell Carcinoma. Eur Urol 2006 Nov 15; [Epub ahead of print].

7. Hafez K.S., Fergany A.F., Novick A.C. Nephron sparing surgery for localized renal cell carcinoma: impact of tumor size on patient survival, tumor recurrence and TNM staging. J Urol 1999;162(6):1930—3.

8. Patard J.J., Shvarts O., Lam J.S. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol 2004;171(6 Pt 1):2181-5, quiz 2435.

9. Leibovich B.C., Blute M.L., Cheville J.C. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol 2004;171(3):1066—70.

10. Frank I., Blute M.L., Cheville J.C. et al. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 2003;170(6 Pt 1):2217—20.

11. Jeschke K., Peschel R., Wakonig L. et al. Laparoscopic nephron-sparing surgery for renal tumors. Urology 2001;58:688—92.

12. Rasweiler J., Abbou C., Janetschek G. et al. Laparoscopic partial nephrectomy, the European experience. Urol Clin North Am 2000;27:721—36.

13. Winfield H.N., Donovan J.F., Lund G.O. et al. Laparoscopic partial nephrectomy: initial experience and comparison to the open surgical approach. J Urol 1995;153:1409—14.

14. Desai M.M., Gill I.S., Kaouk J.H. et al. Laparoscopic partial nephrectomy with suture repair of the pelvicaliceal system. Urology 2003;61:99—104.

15. Novick A.C. Nephron-sparing surgery for renal cell carcinoma. Br J Urol 1998;82:321—4.

16. Li Q.L., Guan H.W., Zhang Q.P. Optimal margin in nephron-sparing surgery for renal cell carcinoma 4 cm or less. Eur Urol 2003;44(4):448—51.

17. Piper N.Y., Bishoff J.T., Magee C. Is a 1-CM margin necessary during nephronsparing surgery for renal cell carcinoma? Urology 2001;58(6):849—52.

18. Akcetin Z., Zugor V., Elsasser D. Does the distance to normal renal parenchyma (DTNRP) in nephron-sparing surgery for renal cell carcinoma have an effect on survival? Anticancer Res 2005;25(3A):1629—32.

19. Duvdevani M., Laufer M., Kastin A. et al. Urology.Is frozen section analysis in nephron sparing surgery necessary? A clinicopathological study of 301 cases. J Urol 2005;173(2):385—7.

20. Kubinski D.J., Clark P.E., Assimos D.G., Hall M.C. Utility of frozen section analysis of resection margins during partial nephrectomy. Urology 2004;64(1):31—4.

21. Timsit M.O., Bazin J.P., Thiounn N. et al. Prospective study of safety margins in partial nephrectomy: intraoperative assessment and contribution of frozen section analysis. Urology 2006;67(5):923—6. Epub 2006 Apr 25.

22. Thompson R.H., Leibovich B.C., Lohse C.M. Complications of contemporary open nephron sparing surgery: a single institution experience. J Urol 2005;174(3):855—8.

23. Ramani A.P., Desai M.M., Steinberg A.P. Complications of laparoscopic partial nephrectomy in 200 cases. J Urol 2005;173(1):42—7.

24. Meng M.V., Freise C.E., Stoller M.L. Laparoscopic nephrectomy, ex vivo excision and autotransplantation for complex renal tumors. J Urol 2004;172(2): 461—4.


Для цитирования:


Матвеев В.Б., Матвеев Б.П., Волкова М.И., Перлин Д.В., Фигурин К.М. Роль органосохраняющего хирургического лечения рака почки на современном этапе. Онкоурология. 2007;3(2):5-11. https://doi.org/10.17650/1726-9776-2007-0-2-5-11

For citation:


Matveev V.B., Matveev B.P., Volkova M.I., Perlin D.V., Figurin K.M. Contemporary roll of organ-preserving surgery of renal cell carcinoma. Cancer Urology. 2007;3(2):5-11. (In Russ.) https://doi.org/10.17650/1726-9776-2007-0-2-5-11

Просмотров: 25


Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.


ISSN 1726-9776 (Print)
ISSN 1996-1812 (Online)
X