Laparoscopic surgery in renal cell carcinoma: from radical surgery to nephron-sparing surgery
DOI:
https://doi.org/10.48193/y7sbze97Keywords:
renal cell carcinoma, laparoscopic surgery, nephrectomyAbstract
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
Escudier B, Porta C, Schmidinger M, Rioux-Leclercq N, Bex A, Khoo V, et al. Renal cell carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol [Internet]. 2019 [citado 3 Jul 2023]; 30(5):706-20. Disponible en: https://doi.org/10.1093/annonc/mdz056.
Ljungberg B, Campbell SC, Cho HY, Jacqmin D, Lee JE, Weikert S, et al. The epidemiology of renal cell carcinoma. Eur Urol [Internet]. 2011 [citado 3 Jul 2023]; 60(4):615-21. Disponible en: https://doi.org/10.1016/j.eururo.2011.06.049.
Callahan CL, Schwartz K, Corley DA, Ruterbusch JJ, Zhao WK, Shuch B, et al. Understanding racial disparities in renal cell carcinoma incidence: estimates of population attributable risk in two US populations. Cancer Causes Control [Internet]. 2020 [citado 3 Jul 2023];31(1):85-93. Disponible en: https://doi.org/10.1007/s10552-019-01248-1.
Rodríguez-Cruzata L. Incidencia del carcinoma de células renales en Santiago de Cuba. Rev Inf Cient [Internet]. 2022 [citado 3 Jul 2023]; 101(1):e3545. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1028-99332022000100008&nrm=iso.
Dirección Nacional de Estadística y Registros Médicos, Ministerio de Salud Pública. Cuadro 40. Mortalidad por tumores malignos según localización. 2020-2021. 2022 [citado 3 Jul 2023]. In: Anuario estadístico de salud 2021[Internet]. La Habana, Cuba: Ecimed. 50a ed.; p. 66. Disponible en: https://temas.sld.cu/estadisticassalud/2022/10/18/anuario-estadistico-de-salud-2021/.
Motzer RJ, Jonasch E, Agarwal N, Alva A, Baine M, Beckermann K, et al. Kidney cancer, version 3.2022, NCCN clinical practice guidelines in oncology. J Nat Comp Cancer Net [Internet]. 2022 [citado 3 Jul 2023]; 20(1):71-90. Disponible en: https://doi.org/10.6004/jnccn.2022.0001.
Vásquez-Lastra C, Castro Gaytán A, Cisneros Madrid B, Lomelín Ramos JP, Vitar Sandoval J, Contreras Escamilla A, et al. Nefrectomía laparoscópica: experiencia en el centro médico ABC, México. An Med Asoc Med Hosp ABC [Internet]. 2021 [citado 3 Jul 2023]; 66(1):36-41. Disponible en: https://dx.doi.org/10.35366/99487.
Vermooten V. Indications for conservative surgery in certain renal tumors: a study based on the growth pattern of the clear cell carcinoma. J Urol [Internet]. 1950 [citado 3 Jul 2023]; 64(2):200-8. Disponible en: https://doi.org/10.1016/S0022-5347(17)68620-8.
Chung HC, Kang TW, Lee JY, Hwang EC, Park HJ, Hwang JE, et al. Tumor enucleation for the treatment of T1 renal tumors: a systematic review and meta-analysis. Investig Clin Urol [Internet]. 2022 [citado 3 Jul 2023]; 63(2):126-39. Disponible en: https://doi.org/10.4111/icu.20210361.
González León T, Suárez Marcillán ME, Bautista Olivé J, Perdomo Leyva D, Rodriguez-Ojea García L, Hernández Castro JL. Cirugía laparoscópica conservadora de nefronas en los tumores renales. Resultado preliminar. Rev Cubana Urol [Internet]. 2014 [citado 3 Jul 2023]; 3(2):11-21. Disponible en: https://revurologia.sld.cu/index.php/rcu/article/view/205/212.
Ljungberg B, Albiges L, Abu-Ghanem Y, Bedke J, Capitanio U, Dabestani S, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 Update. Eur Urol [Internet]. 2022 [Citado 6 Feb 2023]; 82(4):399-410. Disponible en: https://doi.org/10.1016/j.eururo.2022.03.006.
World Medical Association WMA. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama [Internet]. 2013 [Citado 28 Sep 2023]; 310(20):2191-4. Available from: https://doi.org/10.1001/jama.2013.281053.
Morrison JC, Launer BM, Barqawi ZA, Kim SP. Surgical management of the localized renal mass: risk and benefit trade-offs and surgical approach considerations. AME Med J [Internet]. 2020 [citado 3 Jul 2023];6(1):6-15. Disponible en: http://dx.doi.org/10.21037/amj-20-77.
Gayarre-Abril P, López-Lorenzo J, Subirá-Ríos J, Hijazo-Gascón D, Hijazo-Conejos JI, García-Magariño J, et al. Nefrectomía parcial vs enucleación tumoral. Rev Mex Urol [Internet]. 2020 [citado 3 Jul 2023]; 80(6):e07. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2007-40852020000600007&lng=es.
Otaola-Arca H, Mejías O, Krebs A, Lyng R, Orvieto M, Zambrano N, et al. Nefrectomía parcial robótica en tumores ≤ 3 cm. Complicaciones y resultados funcionales y oncológicos a largo plazo. Rev Chil Urol [Internet]. 2023 April 10 [citado 3 Jul 2023]; 88(1):09-19. Disponible en: https://doi.org/10.24875/rechuro.m23000005.
Padala SA, Barsouk A, Thandra KC, Saginala K, Mohammed A, Vakiti A, et al. Epidemiology of renal cell carcinoma. World J Oncol [Internet]. 2020 [citado 3 Jul 2023]; 11(3):79-87. Disponible en: https://doi.org/10.14740%2Fwjon1279.
Abou Elkassem AM, Lo SS, Gunn AJ, Shuch BM, Dewitt-Foy ME, Abouassaly R, et al. Role of imaging in renal cell carcinoma: a multidisciplinary perspective. Radiographics [Internet]. 2021 [citado 3 Sep 2023]; 41(5):1387-407. Disponible en: https://doi.org/10.1148/rg.2021200202.
González-León T, García-Morales I, López-Chacón A, López-Rodríguez I. Laparoscopic enucleation of renal masses. Rev Mex Urol [Internet]. 2022 Jun [citado 10 Ene 2024]; 82(3): e05. Disponible en: https://doi.org/10.48193/revistamexicanadeurologa.v82i3.816.
Chung DY, Kang DH, Kim JW, Kim DK, Lee JY, Cho KS. Comparison of oncologic outcomes between partial nephrectomy and radical nephrectomy in patients who were upstaged from cT1 renal tumor to pT3a renal cell carcinoma: an updated systematic review and meta-analysis. Ther Adv Urol [Internet]. 2020 [citado 3 Sep 2023]; 12:1756287220981508. Disponible en: https://doi.org/10.1016%2Fj.ajur.2019.11.004.
Yu-Li J, Cheng-Xia P, Heng-Zi W, Lu-Jie Q. 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 metaanalysis. BMC Urol [Internet]. 2019 [citado 3 Sep 2023]; 19:48. Disponible en: https://doi.org/10.1186/s12894-019-0480-6.
Scosyrev E, Messing EM, Sylvester R, Van Poppel H. Exploratory subgroup analyses of renal function and overall survival in european organization for research and treatment of cancer randomized trial of nephron-sparing surgery versus radical nephrectomy. Eur Urol Focus [Internet]. 2017 [citado 3 Sep 2023]; 3(6):599-605. Disponible en: https://doi.org/10.1016/j.euf.2017.02.015.
Demirdağ Ç, Çitgez S, Öbek C. Clavien system classification of complications developed following laparoscopic urological operations applied in our clinic. Sisli Etfal Hastanesi tip bulteni [Internet]. 2019 [citado 3 Sep 2023]; 53(3):228-39. Disponible en: https://doi.org/10.14744%2FSEMB.2018.98700.
Perrino CM, Grignon DJ, Williamson SR, Idrees MT, Eble JN, Cheng L. Morphological spectrum of renal cell carcinoma, unclassified: an analysis of 136 cases. Histopathology [Internet]. 2018 [citado 3 Sep 2023]; 72(2):305-19. Disponible en: https://doi.org/10.1111/his.13362.
Aslan R, Taken K, Eryılmaz R. Clinicopathological features and survival data of localized renal masses in young adults. Asian Pac J Cancer Prev [Internet]. 2018 [citado 3 Sep 2023]; 19(11):3233-6. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318400/.
Zhang Y, Long W, Shang H, Ding B, Sun G, Ouyang W, et al. Comparison of the oncological, perioperative and functional outcomes of partial nephrectomy versus radical nephrectomy for clinical T1b renal cell carcinoma: a systematic review and metaanalysis of retrospective studies. Asian J Urol [Internet]. 2021 [citado 3 Sep 2023]; 8: 117-125. Disponible en: https://doi.org/10.1177/1756287220981508.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Revista Mexicana de Urología
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
