Nephron-sparing surgery for renal cell carcinoma in the solitary kidney
| Autor: | Oliver W. Hakenberg, Navid Berdjis, Andreas Manseck, Manfred P. Wirth, Vladimir Novotny, S. Oehlschläger |
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| Rok vydání: | 2007 |
| Předmět: |
Male
Nephrology medicine.medical_specialty Urology medicine.medical_treatment Solitary kidney Renal function urologic and male genital diseases Nephrectomy Renal cell carcinoma Internal medicine medicine Carcinoma Humans Renal Insufficiency Carcinoma Renal Cell Aged Neoplasm Staging Aged 80 and over business.industry Nephrons Middle Aged medicine.disease Kidney Neoplasms Surgery Treatment Outcome Creatinine Disease Progression Female business Kidney cancer Kidney disease |
| Zdroj: | Scandinavian Journal of Urology and Nephrology. 41:10-13 |
| ISSN: | 1651-2065 0036-5599 |
| DOI: | 10.1080/00365590600911225 |
| Popis: | Partial nephrectomy in solitary kidneys carries the risk of tumour progression as well as loss of renal function. We evaluated complications and outcome in patients with renal cell cancer in solitary kidneys who were treated by means of nephron-sparing surgery.Between 1993 and 2003, 38 patients with renal cell carcinoma in a solitary kidney underwent nephron-sparing surgery (partial nephrectomy, n = 37; work-bench resection, n = 1). Of these patients, 21 had asynchronous and eight had synchronous bilateral tumours and underwent contralateral radical nephrectomy. The variables examined were tumour size, disease progression, pre- and postoperative renal function and early (within 30 days of nephron-sparing surgery) and late complications.After a mean follow-up period of 41.7 months (range 8-93 months) the mean serum creatinine level had increased from 1.25 mg/dl preoperatively to 1.62 mg/dl postoperatively. Seventeen patients retained normal renal function and 21 developed some degree of renal insufficiency. New-onset chronic renal insufficiency after nephron-sparing surgery with creatinine levels2 mg/dl was the only late complication observed, occurring in 10 cases. None of the patients required dialysis. Transient urinary leakage was the most frequent early complication, occurring in four cases. Recurrence and/or progression were seen in six patients: four with local recurrence (three of whom also had distant metastases) and two with pure metastatic progression. Nephron-sparing surgery was repeated for the patient with isolated local tumour recurrence. The mean tumour size was 3.8 cm (range 0.7-9.9 cm). Tumour size was markedly greater in patients who developed disease progression (6.2 vs 3.5 cm) and in those who developed renal insufficiency (5.2 vs 3.3 cm).Nephron-sparing surgery for renal cell carcinoma involving a solitary kidney provides effective curative treatment for small tumours, with preservation of renal function. However, patients who undergo partial nephrectomy for locally extensive tumours are at high risk of disease progression. |
| Databáze: | OpenAIRE |
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