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Organo Oficial de la Sociedad Mexicana de Urología

2024, Number 5

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Rev Mex Urol 2024; 84 (5)

Laparoscopic surgery in renal cell carcinoma: from radical surgery to nephron-sparing surgery

Sánchez-Mata JJ, González-León T, Hernández-Campoalegre M, Quintana-Rodríguez M, Sánchez-Tamaki R, Quelle-Santana L

Language: Spanish
References: 27
Page: 1-13
PDF size: 528.47 Kb.


ABSTRACT

Introduction: Renal carcinoma represents 85 % of solid masses.
Objective: To describe the results of laparascopic radical nephrectomy and laparoscopic nephron-sparing surgery in patients with renal cell carcinoma.
Materials and methods: A cohort, retrospective, analytic study of a probability sample of 154 patients with renal carcinoma, Centro Nacional de Cirugía de Mínimo Acceso, Cuba, 2010-2022. Percentages, means and standard deviation were utilized; mean comparisons and to prove associations Ji- square test and Student’s t-test. Survival function was estimated by Kaplan Meier (reliability 95 %).
Results: 59.7 % underwent radical nephrectomy and 40.3 % nephron-sparing surgery. Mean age 57.9 years. 66.2 % were male, 61,7 % ASA II. Incidental diagnosis was more frequent in nephron-sparing surgery (74.2 %). Mean size of the masses was less in nephron–sparing surgery (34.3 mm vs. 53.4 mm), higher postoperative glomerular filtrate (p<0.05) and R.E.N.A.L. score was of low complexity in 58,1 %. 20.1 % of the patients presented complicacions, more frequent in nephron-sparing surgery (p=0,00). Clear-cell carcinoma prevailed (69.5 %), tumoral stage I (86.4 % ). Estimated recurrence at 10 years was lower in patients who had nephron-sparing surgery (94.2 % vs 85.9 %). Cancer-specific survival in patients who underwent radical nephrectomy was 90.2 % (10 years follow-up) vs. nephron-sparing surgery 100 %.
Conclusions: Laparoscopic surgery for renal carcinoma was feasible and safe, with better postoperative renal function, lower recurrence rate and higher cancer-specífic survival in nephron-sparing surgery, albeit presented more postoperative complications.


REFERENCES

  1. Escudier B, Porta C, Schmidinger M, Rioux-Leclercq N, Bex A, Khoo V, et al. Renal cellcarcinoma: ESMO Clinical Practice Guidelinesfor diagnosis, treatment and follow-up†. Annalsof Oncology: Official Journal of the EuropeanSociety for Medical Oncology. 2019;30(5): 706–720. https://doi.org/10.1093/annonc/mdz056.

  2. Ljungberg B, Campbell SC, Choi HY,Jacqmin D, Lee JE, Weikert S, et al. Theepidemiology of renal cell carcinoma. EuropeanUrology. 2011;60(4): 615–621. https://doi.org/10.1016/j.eururo.2011.06.049.

  3. Callahan CL, Schwartz K, Corley DA,Ruterbusch JJ, Zhao WK, Shuch B, et al.Understanding racial disparities in renal cellcarcinoma incidence: Estimates of populationattributable risk in two U.S. populations. Cancercauses & control : CCC. 2020;31(1): 85–93.https://doi.org/10.1007/s10552-019-01248-1.

  4. Rodríguez-Cruzata L. Incidencia del carcinomade células renales en Santiago de Cuba. RevistaInformación Científica. 2022;101(1): 3545.

  5. Dirección Nacional de Estadística y RegistrosMédicos. Anuario Estadístico de Salud 2021. 2021.

  6. Motzer RJ, Jonasch E, Agarwal N, Alva A, BaineM, Beckermann K, et al. Kidney Cancer, Version3.2022, NCCN Clinical Practice Guidelines inOncology. Journal of the National ComprehensiveCancer Network: JNCCN. 2022;20(1): 71–90.https://doi.org/10.6004/jnccn.2022.0001.

  7. Vásquez-Lastra C, Gaytán AC, Madrid BC,Ramos JPL, Sandoval JV, Escamilla AC, et al.Nefrectomía laparoscópica: experiencia en elCentro Médico ABC, México. Anales Médicosde la Asociación Médica del Centro Médico ABC.2021;66(1): 36–41.

  8. Vermooten V. Indications for conservativesurgery in certain renal tumors: a study basedon the growth pattern of the cell carcinoma. TheJournal of Urology. 1950;64(2): 200–208. https://doi.org/10.1016/S0022-5347(17)68620-8.

  9. Chung HC, Kang TW, Lee JY, Hwang EC, ParkHJ, Hwang JE, et al. Tumor enucleation forthe treatment of T1 renal tumors: A systematicreview and meta-analysis. Investigative andClinical Urology. 2022;63(2): 126–139. https://doi.org/10.4111/icu.20210361.

  10. González- León T, Suárez Marcillán M,E,Bautista-Olivé J, Perdomo-Leyva. Cirugíalaparoscópica conservadora de nefronas en lostumores renales. Resultado preliminar. RevistaCubana de Urología. 2014;3(2): 11–21.

  11. Ljungberg B, Albiges L, Abu-Ghanem Y, BedkeJ, Capitanio U, Dabestani S, et al. EuropeanAssociation of Urology Guidelines on RenalCell Carcinoma: The 2022 Update. EuropeanUrology. 2022;82(4): 399–410. https://doi.org/10.1016/j.eururo.2022.03.006.

  12. World Medical Association. World MedicalAssociation Declaration of Helsinki: EthicalPrinciples for Medical Research InvolvingHuman Subjects. JAMA. 2013;310(20):2191–2194. https://doi.org/10.1001/jama.2013.281053.

  13. Morrison JC, Launer BM, Barqawi ZA, Kim SP.Surgical management of the localized renal mass:risk and benefit trade-offs and surgical approachconsiderations. AME Medical Journal. 2021;6(0).https://doi.org/10.21037/amj-20-77.

  14. Gayarre-Abril P, López-Lorenzo J, Subirá-Ríos J, Hijazo-Gascón D, Hijazo-Conejos JI,García-Magariño J, et al. Nefrectomía parcialvs enucleación tumoral. Revista Mexicanade Urología. 2020;80(6): 1–15. https://doi.org/10.48193/revistamexicanadeurologa.v80i6.709.

  15. Otaola H, Mejías O, Krebs A, Lyng R, OrvietoM, Zambrano N. Nefrectomía parcial robóticaen tumores ≤ 3 cm. Complicaciones y resultadosfuncionales y oncológicos a largo plazo. 2023;https://repositorio.udd.cl/handle/11447/7585

  16. Padala SA, Barsouk A, Thandra KC, SaginalaK, Mohammed A, Vakiti A, et al. Epidemiologyof Renal Cell Carcinoma. World Journal ofOncology. 2020;11(3): 79–87. https://doi.org/10.14740/wjon1279.

  17. Abou Elkassem AM, Lo SS, Gunn AJ, ShuchBM, Dewitt-Foy ME, Abouassaly R, et al.Role of Imaging in Renal Cell Carcinoma: AMultidisciplinary Perspective. Radiographics:A Review Publication of the Radiological Societyof North America, Inc. 2021;41(5): 1387–1407.https://doi.org/10.1148/rg.2021200202.

  18. González-León T, García-Morales I, López-Chacón A, López-Rodríguez I, González-León T, García-Morales I, et al. Laparoscopicenucleation of renal masses. Revista Mexicana deUrología. 2022;82(3). https://doi.org/10.48193/revistamexicanadeurologa.v82i3.816.

  19. Chung DY, Kang DH, Kim JW, Kim DK,Lee JY, Cho KS. Comparison of oncologicoutcomes between partial nephrectomy andradical nephrectomy in patients who wereupstaged from cT1 renal tumor to pT3a renalcell carcinoma: an updated systematic reviewand meta-analysis. Therapeutic Advances inUrology. 2020;12: 1756287220981508. https://doi.org/10.1177/1756287220981508.

  20. Jiang YL, Peng CX, Wang HZ, Qian LJ.Comparison of the long-term follow-up andperioperative outcomes of partial nephrectomyand radical nephrectomy for 4 cm to 7 cm renalcell carcinoma: a systematic review and metaanalysis.BMC urology. 2019;19(1): 48. https://doi.org/10.1186/s12894-019-0480-6.

  21. Scosyrev E, Messing EM, Sylvester R, VanPoppel H. Exploratory Subgroup Analyses ofRenal Function and Overall Survival in EuropeanOrganization for Research and Treatment ofCancer randomized trial of Nephron-sparingSurgery Versus Radical Nephrectomy. EuropeanUrology Focus. 2017;3(6): 599–605. https://doi.org/10.1016/j.euf.2017.02.015.

  22. Demirdağ Ç, Çitgez S, Öbek C. Clavien SystemClassification of Complications Developedfollowing Laparoscopic Urological OperationsApplied in our Clinic. Sisli Etfal Hastanesi TipBulteni. 2019;53(3): 228–239. https://doi.org/10.14744/SEMB.2018.98700.

  23. Perrino CM, Grignon DJ, Williamson SR, IdreesMT, Eble JN, Cheng L. Morphological spectrumof renal cell carcinoma, unclassified: an analysisof 136 cases. Histopathology. 2018;72(2): 305–319. https://doi.org/10.1111/his.13362.

  24. Aslan R, Taken K, Eryılmaz R.Clinicopathological Features and Survival Dataof Localized Renal Masses in Young Adults.Asian Pacific journal of cancer prevention:APJCP. 2018;19(11): 3233–3236. https://doi.org/10.31557/APJCP.2018.19.11.3233.

  25. 25, Zhang Y, Long G, Shang H, Ding B, SunG, Ouyang W, et al. Comparison of theoncological, perioperative and functionaloutcomes of partial nephrectomy versusradical nephrectomy for clinical T1b renal cellcarcinoma: A systematic review and metaanalysisof retrospective studies. Asian Journalof Urology. 2021;8(1): 117–125. https://doi.org/10.1016/j.ajur.2019.11.004.

  26. Shao N, Wang HK, Zhu Y, Ye DW. Modificationof American Joint Committee on cancerprognostic groups for renal cell carcinoma.Cancer Medicine. 2018;7(11): 5431–5438.https://doi.org/10.1002/cam4.1790.

  27. Jang HA, Kim JW, Byun SS, Hong SH, KimYJ, Park YH, et al. Oncologic and FunctionalOutcomes after Partial Nephrectomy VersusRadical Nephrectomy in T1b Renal CellCarcinoma: A Multicenter, Matched Case-Control Study in Korean Patients. CancerResearch and Treatment. 2016;48(2): 612–620.https://doi.org/10.4143/crt.2014.122.




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