Residual renal function after partial or radical nephrectomy for renal cell carcinoma

Renal cell carcinoma (RCC) is often detected incidentally and early. Currently, open partial nephrectomy and laparoscopic total nephrectomy form competing technologies. The former is invasive, but nephron-sparing; the other is considered less invasive but with more loss of renal mass. Traditionally, emphasis has been placed on oncologic outcomes. However, a patient with an excellent oncologic outcome may suffer from morbidity and mortality related to renal failure. Animal models with hypertension and diabetic renal disease indicate accelerated progression of pre-existing disease after nephrectomy. Patients with RCC are older and they have a high prevalence of diabetes and hypertension. The progression of renal failure may also be accelerated after a nephrectomy. Our analysis of the available literature indicates that renal outcomes in RCC patients after surgery are relatively poorly defined. A strategy to systematically evaluate the renal function of patients with RCC, with joint discussion between the nephrologist and the oncologic team, is strongly advocated.     

肾癌肾部分切除术后局部复发的临床分析

目的 探讨肾癌肾部分切除术后局部复发的临床特点,对比手术及靶向药物治疗的预后。方法 回顾性分析2006年1月至2019年12月于武汉大学人民医院泌尿外科行肾癌肾部分切除术875例,术后局部复发的19例肾癌患者病历及随访资料。男10例,女9例;中位年龄55(28～72)岁。患者首次复发中位间隔时间为18(3～54)个月。pT_1a期6例,pT_1b期12例,T₂期1例。FuhrmanⅠ～Ⅱ级5例,Ⅲ级10例,Ⅳ级4例。初次手术入路方式：腹腔镜12例,开放7例。二次治疗方式：手术+靶向药物治疗11例,单纯靶向药物治疗8例。二次手术采用腹腔镜手术3例,开放手术8例;重复肾部分切除2例,根治性肾切除9例。结果 PN患者首次复发率为2.2%(19/875),二次手术复发率为36.4%(4/11)。本研究11例二次手术患者中位手术时间215(105～270) min。中位出血量270(100～1 800) ml。术后并发症Ⅰ级5例,Ⅱ级3例,治疗后好转。13例患者(68.4%)出现舒尼替尼副反应,调整用药后好转。19例患者中位随访时间2...     

Cystatin C predicts renal function impairment after partial or radical tumor nephrectomy

International Urology and Nephrology - To test the value of preoperative and postoperative cystatin C (CysC) as a predictor on kidney function after partial (PN) or radical nephrectomy (RN) in...     

Percutaneous ultrasound-guided radiofrequency ablation of recurrent renal cell carcinoma in renal allograft after partial nephrectomy

Percutaneous thermal ablation is increasingly being studied in the treatment of renal tumors. Because radiofrequency ablation is a minimally invasive and nephron-sparing procedure, it is ideally suited for patients with a single kidney, multiple tumors, or contraindications to conventional surgery. We report on a patient with recurrent renal cell carcinoma in a transplanted kidney that was successfully treated with percutaneous ultrasound-guided radiofrequency ablation.     

Surveillance following radical or partial nephrectomy for renal cell carcinoma

Renal cell carcinoma (RCC) is the most lethal of the common urologic malignancies, with approximately 40% of patients eventually dying of cancer progression. Approximately one third of patients present with metastatic disease and up to 50% treated for localized disease have a recurrence. Although the prognosis generally is poor in these patients, some may respond to immunotherapy and a subset of patients who develop solitary metastases can achieve long-term survival. Therefore, the timely identification of recurrences following surgical extirpation is imperative in the treatment of patients.     

Management of locally recurrent renal cell carcinoma after partial nephrectomy

While partial nephrectomy can provide effective treatment for selected patients with renal cell carcinoma, postoperative local tumor recurs in approximately 10 per cent of the cases. We describe 4 patients in whom tumor recurred in a solitary renal remnant after partial nephrectomy for renal cell carcinoma 1 to 6 years previously. The original tumor was pathological stage I in 2 patients and stage III in 2. Neither of the patients with stage I renal cell carcinoma had metastatic disease when locally recurrent carcinoma was noted. A second partial nephrectomy was done in these patients and they are alive 1 and 10 years later. Both patients with stage III renal cell carcinoma also had metastatic disease when locally recurrent carcinoma was noted. One patient died 1 year later and the other is alive 1 year later. Patients who undergo partial nephrectomy for renal cell carcinoma should be followed closely to allow for early detection of local tumor recurrence. When this occurs, secondary surgical treatment may be possible with complete tumor excision and the opportunity for extended survival.     

Experience with partial nephrectomy for renal cell carcinoma

From Sept. 1991 to Jan. 1999, we performed partial nephrectomy on 7 patients with renal cell carcinoma. The indication was imperative for 3 patients, and elective for 4 patients. The 3 imperative cases consisted of bilateral renal cell carcinomas, a polycystic kidney disease and a contralateral atrophic kidney. All 4 patients with elective indication revealed renal cell carcinoma with a normal functioning contralateral kidney. The tumor size ranged from 1.3 cm to 6.0 cm (2.7 cm on average). The mean clamping time of renal artery was 22 minutes and mean blood loss was 400 ml. The pathological stage was pT1a in 6 patients and pT1b in one patient. Postoperative follow-up ranged from 4 months to 92 months (mean: 43 months). One patient with bilateral renal cell carcinoma died of metastases to the lungs and brain at 25 months postoperatively. The remaining 6 patients are alive without recurrence and metastasis. We obtained a good postoperative course in our selected patients with low stage. Thus it was considered that partial nephrectomy is effective against small renal cell carcinoma.     

Surveillance after radical or partial nephrectomy for localized renal cell carcinoma and management of recurrent disease

Surveillance after surgery for RCC is important because approximately 50% of these patients will develop a disease recurrence, two thirds of who will recur within the first year. Although the prognosis is generally poor in these patients, some may respond favorably to immunotherapy. The small subset of patients who develop solitary metastases has the greatest chance to achieve long-term survival. Aggressive surgical resection is an integral part of this success. Proposed surveillance protocols using a stage-based approach or an integrated approach combining stage with other important prognostic factors attempt to provide a rational approach to identifying treatable recurrences while minimizing unnecessary examinations and patient anxiety. However, strict adherence to follow-up guidelines may not be appropriate for all patients. Factors including patient comorbidities and patient willingness to pursue aggressive management in the event of recurrence may alter the follow-up for each individual.     

氮质血症期肾癌患者接受腹腔镜肾部分切除术后的肾功能转归

目的总结氮质血症期肾癌(RCC)患者接受腹腔镜下肾部分切除术(LPN)治疗后的肾功能变化规律,并初步探讨影响其术后透析事件的可能临床因素。方法回顾性总结26例氮质血症期RCC患者的所有临床病理资料及肾功能随诊资料,观察血尿素氮(BUN)、血肌酐(Scr)以及总肾小球滤过率(GFR)的变化趋势,并分析可能影响患者术后透析的临床因素。结果所有患者的年龄范围在54~76岁之间,中位年龄64岁。术后1年内,全组患者中共5例患者(19.2%)的肾功能进入了衰竭期,3例患者(11.5%)接受了血液透析治疗。术后1年时,BUN和Scr分别增长了54.5%和58.5%,而总GFR则减少了32.5%。单因素分析显示:肾功能不全的病因、肿瘤原位分期以及术中失血量可能是影响术后是否需要透析治疗的有意义因素。多因素分析显示:肾功能不全的病因才是术后透析的独立风险因素。结论是否存在术前肾血管狭窄性病变可能是氮质血症期RCC患者术后透析事件的独立风险因素。     

Four-arm robotic partial nephrectomy for complex renal cell carcinoma

Objectives  

Laparoscopic partial nephrectomy (LPN) remains challenging to even experienced laparoscopists. Complex renal tumors add an additional challenge to a minimally invasive approach to nephron-sparing surgery (NSS). We represented our technique and results of robotic partial nephrectomy (RPN) for hilar, endophytic, and multiple renal tumors.     

Open partial nephrectomy for the treatment of renal cell carcinoma

Open partial nephrectomy, or nephron-sparing surgery (NSS), is now considered the standard of care for the treatment of small renal tumors. The oncologic efficacy and safety of NSS for the treatment of stage-T1a renal tumors has been repeatedly demonstrated to be equivalent to radical nephrectomy. NSS initially was reserved for patients with solitary kidneys, impaired renal function, hereditary tumor syndromes, bilateral renal tumors, and those with significant comorbidities predisposing to future renal failure. The indications have expanded recently to allow elective partial nephrectomy in the setting of a normal contralateral kidney. Furthermore, recent data demonstrate that partial nephrectomy for larger tumors (T1b), which have been historically treated with radical nephrectomy, is a viable option when surgical margins can safely be achieved. In the era of minimally invasive techniques, laparoscopic NSS is technically feasible, yet long-term studies are still needed to assess oncologic efficacy. New NSS ablative technologies, such as cryoablation and radiofrequency ablation, are on the horizon. In this article, we discuss the role of open NSS and surgical technique in the contemporary management of renal tumors.     

腹腔镜下冷循环射频消融和肾部分切除术治疗肾癌的临床疗效比较

目的 比较腹腔镜下冷循环射频消融和肾部分切除术治疗肾癌的临床疗效.方法 2005年4月至2008年5月先后采用腹腔镜下冷循环射频消融和肾部分切除术治疗肾细胞癌66例.射频消融组37例,治疗39次.男30例,女7例,平均年龄62岁.肿瘤位于左肾13例,右肾22例,双肾2例.肿瘤最大径2.1～8.5 cm.其中T_1N_0M_032例,T2N0M07例.肾部分切除组29例.男19例,女10例,平均年龄61岁.肿瘤最大径2.0～4.5 cm,平均2.8 cm.统计学比较2组手术前后Hb、红细胞沉降率、SCr、患侧GFR及手术时间、术中平均出血量、术后住院时间、术后并发症发生率等指标.结果 68例次手术均获成功,无中转开放者.射频消融组和肾部分切除组Hb、红细胞沉降率、SCr、患侧GFR与术前比较差异均无统计学意义(P＞0.05).2组手术时间分别为(87±22)、(146±45)min,术中出血量分别为(46±27)、(274±269)ml,术后住院时间分别为(5±1)、(10±2)d,组间比较差异均有统计学意义(P＜0.01).射频消融组术后无明显腹腔镜相关并发症,术后6周39个肾癌病灶完全消融37个(94.9%),消融不全2个;肾部分切除组术后出现漏尿1例,2周后自行愈合.66例术后平均随访20(3～36)个月,无复发及死亡者.结论 腹腔镜下冷循环射频消融治疗肾癌安全有效.在手术时间、术中出血量和术后恢复等方面优于腹腔镜下肾部分切除术.     

Prognostic significance of preoperative kidney volume for predicting renal function in renal cell carcinoma patients receiving a radical or partial nephrectomy

Study Type – Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? At present, many studies have been executed to identify predictors for chronic kidney disease or renal insufficiency after radical nephrectomy or partial nephrectomy. We examined whether preoperative kidney volume is a predictor for renal function after radical or partial nephrectomies in RCC patients. To our knowledge, this is the first study to report on the relationship between preoperative kidney volume and changes in renal function in RCC patients who underwent radical nephrectomy or partial nephrectomy performed by one surgeon.

OBJECTIVE

• ? To investigate whether preoperative kidney volume is a prognostic factor for predicting the postoperative glomerular filtration rate (GFR) in renal cell carcinoma (RCC) patients.

PATIENTS AND METHODS

• ? We included 133 patients who underwent radical (n= 83) or partial (n= 50) nephrectomy for RCC.
• ? Kidney parenchymal volume was measured using personal computer‐based software and GFR was estimated before and after surgery at 6 and 12 months.
• ? We evaluated the change in kidney volume after radical and partial nephrectomy and used regression analysis to identify predictors of lower post‐surgical GFR at 12 months.

RESULTS

• ? The mean volume of the normal side kidney for the radical nephrectomy group increased from 142.4 mL to 166.0 mL (17.2%) and 171.5 mL (21.2%) after surgery at 6 and 12 months, respectively.
• ? In the partial nephrectomy group, the volume of the normal side kidney increased from 127.2 mL to 138.8 mL (9.1%) and 140.6 mL (10.9%) after surgery at 6 and 12 months, respectively.
• ? The volume of the operated side kidney decreased from 128.5 mL to 102.3 mL (20.1%) and 101.8 (20.6%) after surgery at 6 and 12 months, respectively.
• ? In the radical nephrectomy group, older age (P < 0.001), preoperative volume of the normal kidney (P= 0.022) and preoperative GFR for the normal side kidney (P= 0.045) were significant predictors of lower post‐surgical GFR at 12 months.
• ? In the partial nephrectomy group, older age (P= 0.001) and preoperative volume for both kidneys (P= 0.037) were significant predictors of lower post‐surgical GFR at 12 months.

CONCLUSION

• ? Preoperative kidney volume is an independent predictor of GFR in RCC patients who underwent radical or partial nephrectomy.