Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press161410.17650/1726-9776-2023-19-1-141-150REVIEWSОБЗОРЫKidney cancer recurrence: predictors and outcomes of repeat partial nephrectomy (literature review)Рецидив рака почки: предикторы и результаты повторной парциальной нефрэктомии (обзор литературы)https://orcid.org/0000-0002-2359-6973GulievB. G.ГулиевБ. Г.
Russian Federation

Bakhman G. Guliev - Department of Urology, I.I. Mechnikov North-West State Medical University, Ministry of Health of Russia; Urology Center with Robot-Assisted Surgery, Mariinsky Hospital.

41 Kirochnaya St., Saint Petersburg 191015; 56 Liteynyy Prospekt, Saint Petersburg 191014

Гулиев Бахман Гидаятович - профессор кафедры урологии СЗГМУ им. И.И. Мечникова; руководитель Центра урологии СПб ГБУЗ «Городская Мариинская больница».

191015 Санкт-Петербург, ул. Кирочная, 41; 191014 Санкт-Петербург, Литейный пр-кт, 56

gulievbg@mail.ruI.I. Mechnikov North-West State Medical University, Ministry of Health of RussiaФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииMariinsky HospitalСПб ГБУЗ «Городская Мариинская больница»130520231911411500809202201022023https://oncourology.abvpress.ru/oncur/article/view/1614

In the last ten years, the number of organ preservation surgeries for kidney cancer significantly increased. Per literature data, the incidence of recurrences after partial nephrectomy is between 2.9 and 11 %, mostly they are located in the operated or contralateral kidney. Positive surgical margin, high stage and histological subtype of the tumor, as well as hereditary diseases, can serve as predictors for recurrences. In renal cancer recurrences, radical nephrectomy, ablation therapy and repeat tumor resection are possible treatment methods. Kidney resection, same as in primary renal tumors, leads to chronic kidney disease and cardiovascular complications. Different ablation methods, despite their low invasiveness, are not always technically possible. Therefore, in patients with kidney cancer recurrence and satisfactory functional status, repeat partial nephrectomy can be a method of choice. The literature describes the outcomes of open repeat kidney resection with high incidence of general and severe complications. The number of these complications significantly decreased due to the use of robot-assisted access for resection of recurrent renal tumors. Functional characteristics of repeat kidney resections do not significantly decrease, especially in robot-assisted partial nephrectomy. Oncological outcomes of these surgeries remain intermediate, further prospective multi-center trials are needed for their confirmation.

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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