Komplikacije radikalne i parcijalne nefrektomije kod karcinoma bubrežnih ćelija manjih od 7 cm
Sažetak
Uvod/Cilj. Karcinom renalnih ćelija (real cell carcinoma – RCC) treći je najčešći urološki karcinom. Radikalna nefrektomija (RN) smatra se zlatnim standardom u terapiji lokalizovanog RCC, ali u novije vreme sve češće se koriste minimalno invazivne tehnike. Cilj ove studije bio je da se definiše razlika u incidenci intraoperativnih i postoperativnih komplikacija kod bolesika podvrgnutih RN ili parcijalnoj nefrektomiji (PN) zbog RCC veličine do 7 cm. Metode. Retrospektivno su analizirani podaci iz medicinske dokumentacije bolesnika operisanih u šestogodišnjem vremenskom periodu. Kriterijumi za uključivanje u studiju bili su tumor bubrega veličine do 7 cm i odsustvo metastaza. Kriterijum za isključivanje iz studije bilo je prisustvo bilateralnog tumora. Praćene su intraoperativne i rane postoperativne komplikacije. Clavien-Dindo sistem klasifikacije korišćen je za klasifikaciju komplikacija. Rezultati. U periodu od šest godina urađeno je 481 (76.35%) RN i 149 (23.65%) PN. Bilateralni tumori urađeni su kod 2.06% (13/630) bolesnika, inicijalna metastatska bolest kod 15.87% (100/630) i zahvaćenost limfnih čvorova kod 7.14% (45/630) bolesnika i njihovi podaci nisu uzeti u analizu. Analizom je obuhvaćeno 120 bolesnika sa RN i 97 sa PN koji su ispunjavali kriterijume za uključenje u studiju. Komplikacije su zabeležene kod ukupno 29.5% (64/217) bolesnika. Značajno niži broj bolesnika imao je komplikacije u RN grupi [22.5 % (27/120)] u poređenju sa PN grupom [38.1% (37/97)] (p = 0,006). Komplikacije su uglavnom bile gradusa I i II. Komplikacije gradusa III i IV zabeležene su jedino u PN grupi. Zaključak. Na osnovu analize podataka naših bolesnika, PN je dobar i siguran izbor kod RCC veličine do 7 cm, T1 stadijuma. Bolesnik mora biti uključen u donošenje odluke o hirurškom modalitetu koji će biti primenjen.
Reference
Jemal A, Siegel R, Xu J, Ward E. Cancer statistic 2010. CA Can-cer J Clin 2010; 60(5): 277−300.
Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Bor-kowski A,et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2011; 59(4): 543−52.
Robson CJ. Radical nephrectomy for renal cell carcinoma. J Urol 1963; 89: 37−41.
Ljunberg B, Almdari FI, Holmberg G, Granfors T, Duchek M. Radi-cal nephrectomy is stil preferable in the treatment of localized renal cell carcinoma. Eur Urol 1998; 33(1): 79−85.
Cozar JM, Tallada M. Open partial nephrectomy in renal cancer: A feasibile gold standard technique in all hospitals. Adv Urol 2008; 916463.
Shuch B, Lam JS, Belldegrun AS. Open partial nephrectomy for the treatment of renal cell carcinoma. Curr Urol Rep 2006; 7(1): 31−8.
Novick AC, Campbell SC. Tumores renales. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors. Campabell Urology. Bu-enos Aires, Spain: Editorial Panamericana; 2005. p. 2911−79.
Jayson M, Sanders H. Increased incidence of serendipitously dis-covered renal cell carcinoma.Urology 1998; 51(2): 203−5.
Fergany AF, Hafez KS, Novick AC. Long-term results of neph-ron sparing surgery for localized renal cell carcinoma: 10-year follow up. J Urol 2000; 163(2): 442−5.
Moll V, Becht E, Ziegler M. Kidney preserving surgery in renal cell tumors: Indications, technicues and results in 152 patinets. J Urol. 1993; 150(2 Pt 1): 319−23.
Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Mer-seburger AS, et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 2010; 58(3): 398−406.
Peycelon M, Hupertan V, Comperat E, Renard-Penna R, Vaessen C, Conort P, et al. Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol 2009; 181(1): 35−41.
Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lan-cet Oncol 2006; 7(9): 735−40.
Permpongkosol S, Link RE, Su LM, Romero FR, Bagga HS, Pavlo-vich CP, et al. Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J Urol 2007; 177(2): 580−5.
Xu H, Ding Q, Jiang HW. Fewer complications after laparos-copic nephrectomy as compared to the open procedure with the modified Clavien classification system-a retrospective anal-ysis from southern China. World J Surg Oncol 2014; 12: 242.
Yang CM, Chung HJ, Huang YH, Lin TP, Lin AT, Chen KK. Standardized analysis of laparoscopic and robotic-assisted partial nephrectomy complications with Clavien classification. J Chin Med Assoc 2014; 77(12): 637−41.
Stephenson AJ, Hakimi AA, Snyder ME, Russo P. Complications of radical and partial nephrectomy in a large contemporary co-hort. J Urol 2004; 171(1): 130−4.
Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H. Matched comparison of radical nephrectomy vs nephron-sparing sur-gery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 2000; 75(12): 1236−42.
Corman JM, Penson DF, Hur K, Khuri SF, Daley J, Henderson W, et al. Comparison of complications after radical and partial nephrectomy: results from the National Veterans Administra-tion Surgical Quality Improvement Program. BJU Int 2000; 86(7): 782−9.
Lesage K, Joniau S, Fransis K, Van Poppel H. Comparison be-tween open partial and radical nephrectomy for renal tumours: perioperative outcome and health-related quality of life. Eur Urol 2007; 51(3): 614−20.
Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Bor-kowski A, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2011; 59(4): 543−52.
Uzzo RG, Novick AC. Nephron sparing surgery for renal tu-mors: indications, techniques and outcomes. J Urol 2001; 166(1): 6−18.
Shvarts O, Tsui KH, Smith RB, Kernion JB, Belldegrun A. Blood loss and the need for transfusion in patients who undergo partial or radical nephrectomy for renal cell carcinoma. J Urol 2000; 164(4): 1160−3.
Campbell SC, Novick AC, Streem SB, Klein E, Licht M. Complica-tions of nephron sparing surgery for renal tumors. J Urol 1994; 151(5): 1177−80.