Enucleación laparoscópica de masas renales

Autores/as

DOI:

https://doi.org/10.48193/revistamexicanadeurologa.v82i3.816

Palabras clave:

Cáncer Renal, Nefrectomía, Laparoscopia, Período Perioperatorio

Resumen

Introducción: La enucleación tumoral (ET) de las masas renales como alternativa de cirugía conservadora de nefronas se ha incrementado en los últimos años.

Objetivos: Describir los resultados perioperatorios, oncológicos y funcionales de la ET laparoscópica en una serie de pacientes con masas renales.

Material y método: Estudio descriptivo y retrospectivo en 71 pacientes operados de ET laparoscópica por masa renal, en el Centro Nacional de Cirugía de Mínimo Acceso, La Habana, 2010-2019. Se consideraron variables clínicas-epidemiológicas, perioperatorias, las complicaciones, grado Clavien-Dindo y variables oncológicas. Se empleó el programa SPSS versión 23.0. Se calcularon frecuencias, porcentajes medias, desviación estándar y el t student (p<0.05). Para la supervivencia se empleó curva de Kaplan Meier.

Resultados: la edad media fue 58 años. Predominaron los pacientes masculinos (60.6%), con comorbilidades (87.3%), el diagnóstico incidental (73.2%), los tumores de baja complejidad (64.8%). La media del tamaño tumoral y del RENAL score fue 33.6 mm y 6.1, respectivamente. Se empleó abordaje transperitoneal con mano-asistencia en (92.9%), el sangrado medio fue 335.9 ml y la estancia 5.2 días. La función renal postoperatoria se conservó (p=0.082). Predominaron las complicaciones postoperatorias (14.1%) y el sangrado (8.4%) y las grado II y IV (4.2%, respectivamente). La mayoría de las masas fueron malignas (71.8%), predominó el CRcc (52.1%), los pT1a (78.4%), la supervivencia global fue 100% y CE 96,0%. El tiempo medio de seguimiento de 7.4 años.

Conclusiones: La ET laparoscópica es una alternativa de tratamiento factible para el tratamiento de masas renales seleccionadas, con resultados perioperatorios, oncológicos y funcionales satisfactorios.

Citas

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2018;68(6):394–424. doi: https://doi.org/10.3322/caac.21492

Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J, et al. Epidemiology of Renal Cell Carcinoma. Eur Urol. 2019 Jan;75(1):74–84. doi: https://doi.org/10.1016/j.eururo.2018.08.036

Motzer RJ, Jonasch E, Michaelson MD, Nandagopal L, Gore JL, George S, et al. NCCN Guidelines Insights: Kidney Cancer, Version 2.2020. J Natl Compr Canc Netw. 2019 Nov 1;17(11):1278–85. doi: https://doi.org/10.6004/jnccn.2019.0054

Jiang Y-L, Peng C-X, Wang H-Z, Qian L-J. Comparison of the long-term follow-up and perioperative outcomes of partial nephrectomy and radical nephrectomy for 4 cm to 7 cm renal cell carcinoma: a systematic review and meta-analysis. BMC Urology. 2019 Jun 7;19(1):48. doi: https://doi.org/10.1186/s12894-019-0480-6

Leppert JT, Lamberts RW, Thomas I-C, Chung BI, Sonn GA, Skinner EC, et al. Incident CKD after Radical or Partial Nephrectomy. J Am Soc Nephrol. 2018 Jan;29(1):207–16. doi: https://doi.org/10.1681/asn.2017020136

García AG, León TG. Simple Enucleation for Renal Tumors: Indications, Techniques, and Results. Curr Urol Rep. 2016 Jan;17(1):7. doi: https://doi.org/10.1007/s11934-015-0560-4

Dong W, Chen X, Huang M, Chen X, Gao M, Ou D, et al. Long-Term Oncologic Outcomes After Laparoscopic and Robotic Tumor Enucleation for Renal Cell Carcinoma. Frontiers in Oncology. 2021;10. doi: https://doi.org/10.3389/fonc.2020.595457

General Assembly of the World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. J Am Coll Dent. 2014;81(3):14–8.

Minervini A, Vittori G, Lapini A, Tuccio A, Siena G, Serni S, et al. Morbidity of tumour enucleation for renal cell carcinoma (RCC): results of a single-centre prospective study. BJU Int. 2012 Feb;109(3):372–7; discussion 378. doi: https://doi.org/10.1111/j.1464-410x.2011.10360.x

Zhao X, Lu Q, Campi R, Ji C, Guo S, Liu G, et al. Endoscopic Robot-assisted Simple Enucleation Versus Laparoscopic Simple Enucleation With Single-layer Renorrhaphy in Localized Renal Tumors: A Propensity Score-matched Analysis From a High-volume Centre. Urology. 2018 Nov;121:97–103. doi: https://doi.org/10.1016/j.urology.2018.08.015

Manno S, Dell’Atti L, Cicione A, Spasari A. Safety and efficacy of transperitoneal laparoscopic nephron sparing surgery in patients with previous abdominal surgery. Urologia. 2021 Feb;88(1):14–20. doi: https://doi.org/10.1177/0391560320921728

Porpiglia F, Mari A, Amparore D, Fiori C, Antonelli A, Artibani W, et al. Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project). Surg Endosc. 2021 Aug;35(8):4295–304. doi: https://doi.org/10.1007/s00464-020-07919-4

Matos AC, Dall´Oglio MF, Colombo JR, Crippa A, Juveniz JAQ, Argolo FC. Predicting outcomes in partial nephrectomy: is the renal score useful? Int Braz J Urol. 2017;43(3):422–31. doi: https://doi.org/10.1590%2FS1677-5538.IBJU.2016.0315

Shin SJ, Ko KJ, Kim TS, Ryoo HS, Sung HH, Jeon HG, et al. Trends in the Use of Nephron-Sparing Surgery over 7 Years: An Analysis Using the R.E.N.A.L. Nephrometry Scoring System. PLOS ONE. 2015 Nov 24;10(11):e0141709. doi: 10.1371/journal.pone.0141709

Konstantinidis C, Trilla E, Serres X, Montealegre C, Lorente D, Castellón R, et al. Association among the R.E.N.A.L. nephrometry score and clinical outcomes in patients with small renal masses treated with percutaneous contrast enhanced ultrasound radiofrequency ablation. Cent European J Urol. 2019;72(2):92–9. doi: https://doi.org/10.5173/ceju.2019.1833

Tsivian M, Tsivian E, Stanevsky Y, Bass R, Sidi AA, Tsivian A. Laparoscopic partial nephrectomy for tumors 7cm and above. Perioperative outcomes. Int Braz J Urol. 2017 Oct;43(5):857–62. doi: https://doi.org/10.1590/s1677-5538.ibju.2016.0642

Rinott Mizrahi G, Freifeld Y, Klein I, Boyarsky L, Zreik R, Orlin I, et al. Comparison of Partial and Radical Laparascopic Nephrectomy: Perioperative and Oncologic Outcomes for Clinical T2 Renal Cell Carcinoma. J Endourol. 2018 Oct;32(10):950–4. doi: https://doi.org/10.1089/end.2018.0199

Dell’Atti L, Scarcella S, Manno S, Polito M, Galosi AB. Approach for Renal Tumors With Low Nephrometry Score Through Unclamped Sutureless Laparoscopic Enucleation Technique: Functional and Oncologic Outcomes. Clin Genitourin Cancer. 2018 Dec;16(6):e1251–6. doi: https://doi.org/10.1016/j.clgc.2018.07.020

George Rahota R, Valean D, Dobrota F, Andras I, Rahota AC, Maghiar TT, et al. Is 3D laparoscopic off clamp simple enucleation a feasible alternative for clinical T1 renal tumors? Outcomes from a single center experience. J BUON. 2021 Jun;26(3):1088–93.

Xu C, Lin C, Xu Z, Feng S, Zheng Y. Tumor Enucleation vs. Partial Nephrectomy for T1 Renal Cell Carcinoma: A Systematic Review and Meta-Analysis. Frontiers in Oncology. 2019;9. doi: https://doi.org/10.3389/fonc.2019.00473

Blackwell RH, Li B, Kozel Z, Zhang Z, Zhao J, Dong W, et al. Functional Implications of Renal Tumor Enucleation Relative to Standard Partial Nephrectomy. Urology. 2017 Jan 1;99:162–8. doi: https://doi.org/10.1016/j.urology.2016.07.048

Tonolini M, Ierardi AM, Varca V, Incarbone GP, Petullà M, Bianco R. Multidetector CT imaging of complications after laparoscopic nephron-sparing surgery. Insights Imaging. 2015 Aug;6(4):465–78. doi: https://doi.org/10.1007%2Fs13244-015-0413-1

Minervini A, Campi R, Di Maida F, Mari A, Montagnani I, Tellini R, et al. Tumor-parenchyma interface and long-term oncologic outcomes after robotic tumor enucleation for sporadic renal cell carcinoma. Urol Oncol. 2018 Dec;36(12):527.e1-527.e11. doi: https://doi.org/10.1016/j.urolonc.2018.08.014

Dominique I, Dariane C, Fourniol C, Le Guilchet T, Hurel S, Fontaine E, et al. Performing an early systematic Doppler-ultrasound fails to prevent hemorrhagic complications after complex partial nephrectomy. Ther Adv Urol. 2019 Dec;11:1756287219828966. doi: https://doi.org/10.1177/1756287219828966

Chen J, Yang M, Wu P, Li T, Ning X, Peng S, et al. Renal Arterial Pseudoaneurysm and Renal Arteriovenous Fistula Following Partial Nephrectomy. Urol Int. 2018;100(3):368–74. doi: https://doi.org/10.1159/000443700

Ren W, Xue B, Qu J, Liu L, Li C, Zu X. Localized chromophobe renal cell carcinoma: preoperative imaging judgment and laparoscopic simple enucleation for treatment. Int Braz J Urol. 2018 Oct;44(5):922–32. doi: https://doi.org/10.1590/s1677-5538.ibju.2017.0519

Wang L, Hughes I, Snarskis C, Alvarez H, Feng J, Gupta GN, et al. Tumor enucleation specimens of small renal tumors more frequently have a positive surgical margin than partial nephrectomy specimens, but this is not associated with local tumor recurrence. Virchows Arch. 2017 Jan;470(1):55–61. doi: https://doi.org/10.1007/s00428-016-2031-9

Cao D-H, Liu L-R, Fang Y, Tang P, Li T, Bai Y, et al. Simple tumor enucleation may not decrease oncologic outcomes for T1 renal cell carcinoma: A systematic review and meta-analysis. Urol Oncol. 2017 Nov;35(11):661.e15-661.e21. doi: https://doi.org/10.1016/j.urolonc.2017.07.007

Minervini A, Campi R, Lane BR, De Cobelli O, Sanguedolce F, Hatzichristodoulou G, et al. Impact of Resection Technique on Perioperative Outcomes and Surgical Margins after Partial Nephrectomy for Localized Renal Masses: A Prospective Multicenter Study. J Urol. 2020 Mar;203(3):496–504. doi: https://doi.org/10.1097/ju.0000000000000591

Descargas

Publicado

2022-06-30 — Actualizado el 2022-07-04

Versiones

Número

Sección

Artículos originales