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Роль органосохраняющего хирургического лечения рака почки на современном этапе

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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

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

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

Д. В. Перлин
Отделение трансплантации почки НИИ урологии

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

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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.

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.)

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