Wyniki leczenia operacyjnego raka nerki w I Klinice Urologii Uniwersytetu Medycznego w Łodzi w latach 2004–2010
Results of surgical treatment of kidney cancer in the Department of Urology, Medical University of Lodz in 2004–2010
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Introduction. Aim of the study: The only effective treatment method for all forms of the kidney cancer is surgery with possible subsequent institution of neoadjuvant treatment. The standard management involves nephrectomy with or without lymphadenectomy and adrenalectomy. In patients with kidney tumors up to 4 cm in diameter, surgical procedures saving the renal parenchyma (Nephron-Sparing Surgery – NSS) are currently performed. The objective was the retrospective analysis of the treatment results obtained in renal cancer patients who had undergone surgical procedures. The results of the treatment following nephrectomy performed from transperitoneal and retroperitoneal approach were compared with those obtained after NSS type procedures. Material and methods: The study was carried out in 238 patients: 107 women and 131 men with kidney cancer, operated on in the years 2004 – 2010. In 15 patients distant metastases were found. The nephrectomy was performed in 69 patients from transperitoneal access and in 105 patients from retroperitoneal access with NSS procedures in 55 patients. The transperitoneal approach was used in patients with large tumors ranging > 6 cm size. Other patients were operated on with lumbar access, also those with tumors < 4 cm, since that approach was used for NSS procedures. The intraoperative and postoperative period, the duration of the surgery, complications, hospitalization time, analgesic treatment and overall survival were evaluated. Results: The operated patients were hospitalized for 11 days on the average, and the mean time of the surgical procedure was ca. 168 minutes. Intraoperative blood loss during most of the performed procedures was without clinical significance but the largest blood loss during the operation was reported in the patients with kidney tumors > 10 cm during transperitoneal access surgery. The blood loss was compensated in 33 cases by the administration of RBC preparations in 21.74% of the patients after transperitoneal access surgeries and 10.65% of those after lumbar access. Retroperitoneal access was associated with the use of larger quantities of analgesic medications in the postoperative period. Histopathological investigations resulted with clear cell carcinoma in 85% of the patients, in other 15% of the cases, most commonly diagnosed with chromophobe and papillary carcinomas. The malignancy grade of RCC according to Fuhrman scale; Fuhrman 1 – 7.98%, Fuhrman 2 – 61.38%, Fuhrman 3 – 9.66%, Fuhrman 4 – 5.88%. Fuhrman grades 3 and 4 were, however, more common in the patients with the big tumors undergoing transperitoneal access. The local advancement of the removed kidney tumors according to TNM classification: stage pT1 in 156 patients, stage pT2 in 52 and pT3 in 1 patient. The distribution of diagnoses and staging was similar for both surgical approaches. The results of kidney cancer treatment were reflected by the assessment of 5–year survival of the patients. Such analysis was possible only in the subgroup of 115 patients who had undergone the surgery in the years 2004 – 2007. The obtained data indicated the overall 5–year survival rate amounting to 58.3% of the reviewed subgroup, whereas 48 patients, i.e. 41.7% died. The causes of death were not possible to know. It is noteworthy that the group of deaths included all the patients operated on at the metastatic stage of the disease. Conclusions: In large renal tumors > 6 cm size, transperitoneal access nephrectomy was preferred. In the remaining patients lumbar access procedures were performed, including kidney-sparing surgery. Fuhrman grade 3 and 4 clear cell tumors are predominant in the patients operated on with transperitoneal access. The number of intra- and postoperative complications is similar in both groups. The use of transperitoneal access is associated with an increase in the amount of analgesics administered in the postoperative course, longer duration of the surgical procedure and longer hospitalization time. The overall 5–year survival rate for the group of 115 patients operated on in the years 2004–2007 was 58.3%.
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