Practical aspects of treatment of kidney cancer in a modern hospital: the evolution of surgical approaches

Objective: analysis of results of the outcomes of surgical treatment for renal tumors in the Saint Petersburg City Hospital No. 40 over the last 5 years and determination the trends.

Materials and methods. The study included 293 patients that underwent 296 surgeries for renal tumors. The majority of patients (87.84 %) were diagnosed with localized cancer, whereas locally advanced and metastatic forms were detected in 4.39 and 7.77 % of cases respectively. We performed radical nephrectomy (RNE) or nephron sparing (NS) via open or minimally invasive route (videoendoscopic or robot-assisted surgery using the da Vinci Surgical System).

Results. Organ-preserving surgeries were performed in 52.36 % of patients, RNE – in 47.64 % of patients; minimally invasive and open surgeries were conducted in 95.95 and 4.05 % respectively. In individuals with stage cT1a cancer, NS and RNE were performed in 87 and 13 % of cases respectively; in patients with stage cT1b cancer, NS and RNE were performed in 50.82 and 49.18 % of cases respectively. The majority (90.2 %) of patients with renal tumors >7 cm underwent minimally invasive surgeries, primarily RNE. The incidence of severe postoperative complications after NS and RNE was comparable: 5.75–8.06 and 1.67–15.38 % respectively (р = 0.64).

Conclusion. Minimally invasive NS is the method of choice for stage сT1 tumors; however, in some cases, we should also consider it for tumors >7 cm. Videoendoscopic surgery is the most preferable option for these patients, whereas robot-assisted techniques should be used for organpreserving surgeries and RNE in difficult cases.

1. Jemal A., Bray F., Centr M.M. et al. Global cancer statistics. CA Cancer J Clin 2011;61(2):69–90. DOI: 10.3322/caac.20107. PMID: 21296855.

2. Ferlay J., Soerjomataram I., Dikshit R. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136(5):E359–86. DOI: 10.1002/ijc.29210. PMID: 25220842.

3. Malignant tumors in Russia in 2015 (morbidity and mortality). Eds.: А.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Moscow: MNIOI im. P.A. Gertsena – filial FGBU “NMIRTS” Minzdrava Rossii, 2017. 250 p. (In Russ.).

4. Huang W.C., Elkin E.B., Levey A.S. et al. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors – is there a difference in mortality and cardiovascular outcomes? J Urol 2009;181(1):55–61. DOI: 10.1016/j.juro.2008.09.017. PMID: 19012918.

5. Kates M., Badalato G.M., Pitman M., McKiernan J.M. Increased risk of overall and cardiovascular mortality after radical nephrectomy for renal cell carcinoma 2 cm or less. J Urol 2011;186(4):1247–53. DOI: 10.1016/j.juro.2011.05.054. PMID: 21849201.

6. Miller D.C., Schonlau M., Litwin M.S. et al. Renal and cardiovascular morbidity after partial or radical nephrectomy. Cancer 2008;112(3):511–20. DOI: 10.1002/cncr.23218. PMID: 18072263.

7. Kutikov A., Smaldone M.C., Uzzo R.G. Partial versus radical nephrectomy: balancing nephrons and perioperative risk. Eur Urol 2013;64(4):607–9. DOI: 10.1016/j.eururo.2013.01.020. PMID: 23375430.

8. Kaushik D., Kim S.P., Childs M.A. et al. Overall survival and development of stage IV chronic kidney disease in patients undergoing partial and radical nephrectomy for benign renal tumors. Eur Urol 2013;64(4):600–6. DOI: 10.1016/j.eururo.2012.12.023. PMID: 23280319.

9. Ljungberg B., Hanbury D.C., Kuczyk M.A. et al. Renal cell carcinoma guideline. Eur Urol 2007;51(6):1502–10. DOI: 10.1016/j.eururo.2007.03.035. PMID: 17408850.

10. Campbell S., Uzzo R.G., Allaf M.E. et al. Renal mass and localized renal cancer: AUA guideline. J Urol 2017;198(3):520–9. DOI: 10.1016/j.juro.2017.04.100. PMID: 28479239.

11. Loran O.B., Seregin A.V., Shustitskiy .A. Technical characteristics of organpreserving surgeries for renal cancer. Meditsinskiy vestnik Bashkortostana = Bashkortostan Medical Journal 2013;8(2):197–201. (In Russ.).

12. Volkova M.I., Skvortsov I.Ya., Klimov A.V. et al. Impact of surgical volume on functional results and cardiospecific survival rates in patients with clinically localized renal cancer. Onkourologiya = Cancer Urology 2014;(3):22–30. (In Russ.).

13. Alekseev B.Ya., Anzhiganova Yu.V., Lykov A.V. et al. Some specific features of the diagnosis and treatment of kidney cancer in Russia: preliminary results of a multicenter cooperative study. Onkourologiya = Cancer Urology 2012(3): 24–30. (In Russ.).

14. Clavien P.A., Barkun J., de Oliveira M.L. et al. The Clavien–Dindo classification of surgical complications: five year experience. Ann Surg 2009;250(2):187–96. DOI: 10.1097/SLA.0b013e3181b13ca2. PMID: 19638912.

15. Olbert P.J., Maier M., Heers H. et al. Indications for nephron-sparing surgery. Analysis over a 13-year period in the context of changing guidelines. Urologe A 2015;54(6):804–10. DOI: 10.1007/s00120-014-3710-2. PMID: 25503720.

16. Minervini A., Vittori G., Antonelli A. et al. Open versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications. World J Urol 2014;32(1):287–93. DOI: 10.1007/s00345-013-1136-x. PMID: 23913095.

17. Sun M., Abdollah F., Shariat S.F. et al. Propensity-score matched comparison of complications, blood transfusions, length of stay, and in-hospital mortality between open and laparoscopic partial nephrectomy: a national series. Eur J Surg Oncol 2012;38(1):80–7. DOI: 10.1016/j.ejso.2011.09.035. PMID: 21996370.

18. Hadjipavlou M., Khan F., Fowler S. et al. Partial vs radical nephrectomy for T1 renal tumours: an analysis from the British Association of Urological Surgeons Nephrectomy Audit. BJU Int 2015;117(1):62–71. DOI: 10.1111/bju.13114. PMID: 25754386.

19. Autorino R., Zargar H., Butler S. et al. Incidence and risk factors for 30-day readmission in patients undergoing nephrectomy procedures: a contemporary analysis of 5276 cases from the National Surgical Quality Improvement Program database. Urology 2015;85(4):843–9. DOI: 10.1016/j.urology.2014.11.044. PMID: 25681252.

20. Meyer C., Hansen J., Becker A. et al. The adoption of nephron-sparing surgery in Europe – a trend analysis in two referral centers from Austria and Germany. Urol Int 2016;96(3):330–6. DOI: 10.1159/000442215. PMID: 26699625.

21. Lista G., Buffi N.M., Lughezzani G. et al. Margin, ischemia, and complications system to report perioperative outcomes of robotic partial nephrectomy: a European Multicenter Observational Study (EMOS project). Urology 2015;85(3):589–95. DOI: 10.1016/j.urology.2014.09.068. PMID: 25733270.

22. Mathieu R., Verhoest G., Droupy S. et al. Predictive factors of complications after robot-assisted laparoscopic partial nephrectomy: a retrospective multicentre study. BJU Int 2013;112(4):E283–9. DOI: 10.1111/bju.12222. PMID: 23879913.

23. Nogueira L., Katz D., Pinochet R. et al. Critical evaluation of perioperative complications in laparoscopic partial nephrectomy. Urology 2010;75(2):288–94. DOI: 10.1016/j.urology.2009.09.036. PMID: 19963244.

24. Alemozaffar M., Chang S.L., Kacker R. et al. Comparing costs of robotic, laparoscopic, and open partial nephrectomy. J Endourol 2013;27(5):560–5. DOI: 10.1089/end.2012.0462. PMID: 23130756.

25. Mano R., Schulman A., Hakimi A.A. et al. Cost comparison of open and robotic partial nephrectomy using a short postoperative pathway. Urology 2015;85(3):596– 603. DOI: 10.1016/j.urology.2014.10.044. PMID: 25586478.