medigraphic.com
ISSN 2305-7939 (Electronic)

2014, Number 2

<< Back Next >>

RCU 2014; 3 (2)

Cirugía laparoscópica conservadora de nefronas en los tumores renales. Resultado preliminar

González LT, Suárez MME,Bautista OJ, Perdomo LD

Language: Spanish
References: 40
Page: 11-21
PDF size: 786.60 Kb.


ABSTRACT

Introduction: The development of diagnosis through imaging has allowed the detection of small kidney tumors when the disease is in its early stages. Although Radical Nephrectomy (RN) is still the most common treatment, nephron sparing surgery (NSS) is displacing it with similar oncological results and a favorable effect in overall kidney function. Laparoscopic nephron sparing surgery (L-NSS) is a complex technique that requires great specialization and experience. Objective: To show the preliminary results of L-NSS in a series of patients. Methods: A descriptive study is carried out with 14 patients who underwent L-NSS at the National Center of Minimal Invasive Surgery (NCMIS). Tumors were evaluated by imaging studies and the R.E.N.A.L. score was used. L-NSS was performed by transperitoneal approach and hand-assistance or by lumboscopic approach. The technique was considered feasible, when conversion to open surgery was not required. Complications were classified according to Clavien-Dindo. Results: The average age was 51.5 %; female patients and incidental diagnosis prevailed. L-NSS was feasible in 85.7 %. The average operative time was 171 minutes and bleeding was 272.8 ml. Postoperative hospital stay was 3.1 days. There were four complications (28.4%), only one grade V. 78.5% were stage T1a. Renal carcinoma prevailed. Surgical margin (PSM) was positive in one case and there was one tumor recurrence. Neither metastasis nor cancer-related diseases occurred. Conclusions: L-NSS has shown satisfactory preliminary results at the NCMIS which makes it a safe and feasible alternative for the treatment of T1 kidney tumors.


REFERENCES

  1. Ljungberg B, Campbell SC, Cho HJ, Jacqmin D, Lee JE, Weikert S, Kiemeney LA. The epidemiology of renal cell carcinoma. Eur Urol. 2011; 60 (4):615-21. [PubMed]

  2. Luczynska E, Dyczek S, Heinze-Paluchowska S, Komorowski A, Pawlik T, Wysocki W, et all. Nephrectomy or nephron-sparing surgery - how to decide? Contemp Oncol (Pozn). 2013; 17(1):88-93. [PubMed]

  3. Gandaglia G, Ravi P, Abdollah F, Abd-El-Barr AE, Becker A, Popa I, et al. Contemporary incidence and mortality rates of kidney cancer in the United States. Can Urol Assoc J. 2014 Jul;8(7-8):247-52.

  4. Osawa T, Harada H, Oba K, Seki T, Togashi M. Clinical factor affecting the recovery of kidney function in clinically localized renal cell carcinoma patients who underwent nephron-sparing surgery. Hokkaido Igaku Zasshi. 2013; 88(1):15-20. [PubMed]

  5. Volpe A, Amparore D, Mottrie A. Treatment outcomes of partial nephrectomy for T1b tumours. Curr Opin Urol. 2013; 23(5): 403-10. [PubMed]

  6. Glazar W, Dobrowolska-Glazar B, Urbanowicz W, Su?owicz W. Clinical consequences of nephrectomy performed on medical grounds. Przegl Lek. 2014; 71(1):1-4. [PubMed]

  7. Tomaszewski JJ, Uzzo RG, Kutikov A, Hrebinko K, Mehrazin R, Corcoran A et al. Assessing the burden of complications after surgery for clinically localized kidney cancer by age and comorbidity status. Urology. 2014; 83(4):843-50. [PubMed]

  8. Thorstenson A, Bergman M, Scherman-Plogell AH, Hosseinnia S, Ljungberg B, Adolfsson J et al. Tumour characteristics and surgical treatment of renal cell carcinoma in Sweden 2005-2010: a population-based study from the National Swedish Kidney Cancer Register. Scand J Urol. 2014 Mar 25. [PubMed]

  9. Krabbe LM, Bagrodia A, Margulis V, Wood CG. Surgical Management of Renal Cell Carcinoma. Semin Intervent Radiol. 2014; 31(1):27-32. [PubMed]

  10. Kreshover JE, Kavoussi LR, Richstone L. Hilar clamping versus off-clamp laparoscopic partial nephrectomy for T1b tumors. Curr Opin Urol. 2013; 23(5): 399-402. [PubMed]

  11. Matthew R. Hotston , Francis X. Keeley. Nefrectomía parcial laparoscópica sin isquemia. Arch. Esp. Urol. 2013; 66 (1): 146-151. [PubMed]

  12. Pace G, Micheli E, Valenti S, Borgonovo G, Vismara A, Tocco A, et al. Nephron sparing surgery in renal cell carcinoma: our experience of a 20-year clinical practice. Urologia. 2013; 80(2):130-4. [PubMed]

  13. Bolufer E, López-Fontana G, Castillo OA. Robot assisted partial nephrectomy (Da Vinci) in an angiomyolipoma associated to Wünderlich Syndrome. Arch Esp Urol. 2012; 65(9): 831-4. [PubMed]

  14. González T, Casanova G, Machado M, Faife B, Rodríguez E, Bautista J. Laparoscopic hand-assisted radical nephrectomy. Cuban experience. J Endourology. 2007; 21 (S1): A271. http://eurekamag.com/research/021/258

  15. Kobayashi K, Saito T, Kitamura Y, Nobushita T, Kawasaki T, Hara N, et al. The RENAL Nephrometry Score and the PADUA Classification for the Prediction of Perioperative Outcomes in Patients Receiving Nephron-Sparing Surgery: Feasible Tools to Predict Intraoperative Conversion to Nephrectomy. Urol Int. 2013; 91(3):261-8. [PubMed]

  16. SankarA, Johnson SR, BeattieWS, Tait G, Wijeysundera D N. Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth. 2014 Apr 11. [Epub ahead of print]. [PubMed]

  17. Gaur DD, Trivedi S, Prabhudesai MR, Madhusudhana HR, Gopichand M. Laparoscopic ureterolithotomy: technical considerations and long-term follow-up. BJU Int. 2002; 89 (4): 339-43. [Pubmed]

  18. Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol. 2010; 58(3):398-406.

  19. Mitropoulos D, Artibarni W, Graefen M, Remzi M, Roupret M, Truss M. Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU Guidelines Panel assessment and recommendations. Eur Urol. 2012; 61 (2):341-9. Disponible en: http://www.sciencedirect.com

  20. Tanagho YS, Kaouk JH, Allaf ME, Rogers CG, Stifelman MD, Kaczmarek BF et al. Perioperative complications of robot-assisted partial nephrectomy: analysis of 886 patients at 5 United States centers. Urology. 2013; 81(3): 573-9. [Pubmed]

  21. Konnak JW, Grossman HB. Renal cell carcinoma as an incidental finding. J Urol 1985; 134: 1094-6. [Pubmed]

  22. Woldrich JM, Palazzi K, Stroup SP, Sur RL, Parsons JK, Chang D, Derweesh IH. Trends in the surgical management of localized renal masses: thermal ablation, partial and radical nephrectomy in the USA, 1998-2008. BJU Int. 2013; 111(8): 1261-8. [Pubmed]

  23. Khalifeh A, Kaouk JH, Bhayani S, Rogers C, Stifelman M, Tanagho YS, Kumar R, Gorin MA, Sivarajan G, Samarasekera D, Allaf ME. Positive surgical margins in robot-assisted partial nephrectomy: a multi-institutional analysis of oncologic outcomes (leave no tumor behind). J Urol. 2013; 190(5):1674-9. [Pubmed]

  24. Sammon J, Karakiewicz PI, Sun M, Ravi P,.Ghani K R, Jeong W et al. Robot-assisted vs. Laparoscopic Partial Nephrectomy: utilization rates and perioperative outcomes. Braz J Urol. 2013; 39 (3): 377-386. [Pubmed]

  25. Klatte T, Shariat SF, Remzi M. Systematic review and meta-analysis of perioperative and oncologic outcomes of laparoscopic cryoablation versus laparoscopic partial nephrectomy for the treatment of small renal tumors. J Urol. 2014 May; 191(5):1209-17.

  26. Strup SE, Hubosky S. Hand-assisted laparoscopic partial nephrectomy. J Endourol. 2004; 18(4):345-9. [Pubmed]

  27. Doehn C, Witzsch U, Siebels M. Active surveillance for renal cell carcinoma. Aktuelle Urol. 2012; 43(4):243-9. [Pubmed]

  28. Ferguson JE , Goyal RK, Raynor MC, Nielsen ME, Pruthi RS, Brown PM et al. Cost analysis of robot-assisted laparoscopic versus hand-assisted laparoscopic partial nephrectomy. J Endourol. 2012; 26(8):1030-7. [Pubmed]

  29. Ren T, Liu Y, Zhao X, Ni S, Zhang C, Guo C et al. Transperitoneal approach versus retroperitoneal approach: a meta-analysis of laparoscopic partial nephrectomy for renal cell carcinoma. PLoS One. 2014 Mar 21; 9(3):e91978. doi: 10.1371/journal.pone.0091978. eCollection 2014.

  30. Peña JA, Oliveira M, Ochoa DC, Santillana JM, Skrobot SA, Castellarnau S et al. The road to real zero ischemia for partial nephrectomy. J Endourol. 2013; 27(7): 936-42. [Pubmed]

  31. Fogarty JD, Hafron JM, Hoenig DM, Ghavamian R. Laparoscopic nephron-sparing msurgery for the small exophytic renal mass. JSLS. 2005 Apr-Jun; 9(2):199-204.

  32. Moore NW1, Nakada SY, Hedican SP, Moon TD. Complications of hand-assisted laparoscopic renal surgery: single-center ten-year experience. Urology. 2011; 77(6):1353-8. [Pubmed]

  33. Salami SS, George AK, Rais-Bahrami S, Okhunov Z, Waingankar N, Kavoussi LR. Off-clamp laparoscopic partial nephrectomy for hilar tumors: oncologic and renal functional outcomes. J Endourol. 2014; 28 (2): 191:5.[Pubmed]

  34. Kim TS, Oh JH, Rhew HY. "Off-clamp, non-renorrhaphy" laparoscopic partial nephrectomy with perirenal fatand Gerota's fascia reapproximation: initial experience and perioperative outcomes. J Laparoendosc Adv Surg Tech A. 2014 May; 24(5):339-44.

  35. Hsieh PF, Chang CH, Huang CP, Chen CC, Chen KL, Chang SS et al. The impact of gender and size on the pathology of small renal mass. Kaohsiung J Med Sci. 2012; 28(7): 369-72.

  36. Waldert M, Waalkes S, Klatte T, Kuczyk MA, Weibl P, Schüller G et al. External validation of the preoperative anatomical classification for prediction of complications related to nephron-sparing surgery.World J Urol. 2010;28(4): 531-5. [Pubmed]

  37. EsenT, Acar Ö,Llu AM, Vura lM, Akpek S. Nephron-sparing surgery for renal masses measuring largerthan 7 cm on preoperative imaging: a single surgeon, singlecenter experience. ISRN Surgery. 2013; 2013: 691080. [Pubmed]

  38. Ljungberg B, Gudmundsson E, Christensen S, Lundstam S; for the Swedish Kidney Cancer Quality Register Group. Practice patterns for the surgical treatment of T1 renal cell carcinoma: A nationwide population-based register study. Scand J Urol. 2014; 48 (5): 445-52. [Epub ahead of print] [Pubmed]

  39. Zeccolini G, Del Biondo D, Cicero C, Casarin A, Guarise A, Celia A. Comparison of Contrast-Enhanced Ultrasound Scan (CEUS) and MRI in the follow-up of cryoablation for small renal tumors. Experience on 25 cases. Urologia. 2014 Mar 6; 81(Suppl. 23):1-8. doi: 10.5301/RU.2014.11986. [Epub ahead of print]

  40. Scosyrev E, Messing EM, Sylvester R, Campbell S, V. Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904. Eur Urol. 2014; 65(2):372-7. [Pubmed]




2020     |     www.medigraphic.com