Роль органосохраняющего хирургического лечения рака почки на современном этапе

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.