Рецидив рака почки: предикторы и результаты повторной парциальной нефрэктомии (обзор литературы)

За последнее десятилетие количество органосохраняющих операций при раке почки значительно увеличилось. По данным литературы, после парциальной нефрэктомии частота рецидивов колеблется от 2,9 до 11 %, в основном они локализуются в оперированной или контралатеральной почке. Предикторами их развития могут быть положительный хирургический край, высокая стадия и гистологический подтип опухоли, а также наследственные заболевания. При рецидивах рака почки возможны такие варианты лечения, как радикальная нефрэктомия, аблационная терапия и повторная резекция опухоли. Удаление почки, как и при первичных ренальных опухолях, ведет к развитию хронической болезни почек и сердечно-сосудистых осложнений. Различные методы аблации, несмотря на их малоинвазивность, не всегда технически выполнимы. Поэтому у пациентов с рецидивом рака почки и неотягощенным соматическим статусом методом выбора может быть повторная парциальная нефрэктомия. В литературе описаны результаты открытой повторной резекции почки с высокой частотой общих и серьезных осложнений. Количество этих осложнений значительно уменьшилось при использовании роботического доступа для удаления рецидивных ренальных опухолей. Функциональные показатели после повторных резекций почки ухудшаются незначительно, особенно при робот-ассистированной парциальной нефрэктомии. Онкологические результаты данных операций являются еще промежуточными, для их подтверждения необходимы дальнейшие проспективные исследования.

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