The attempt to estimation renal insufficiency risk factors after nephron-sparing surgery (NSS) in patients with neoplasmatic tumor of solitary kidney
Article published in Urologia Polska 2007/60/1.
Mieczysław Fryczkowski, Andrzej Kupilas, Andrzej Paradysz, Maciej Szczębara
- Katedra i Klinika Urologii w Zabrzu Śląskiej Akademii Medycznej w Katowicach
ren solitaris, neoplasmatic tumor, NSS, kidney insufficiency
- Introduction. Renal insufficiency as well as oncologic radicality plays an important role in surgical nephron-sparing surgery (NSS) in patients with solitary kidney tumor.
- Material and method. Retrospective analysis was performed in 27 patients who undergone NSS in period 5-103 months before. Patients were analysed in 2 groups: I group consisted of 14 patients suffered from renal insufficiency, II group consisted of 13 patients without renal insufficiency. In both groups morphological and clinical factors of renal insufficiency were considered. In 8 patients parenchymal resection was applied, 19 patients undergone tumor excavation (enucleoresectio). Follow-up was performed accoording to EORTC guidelines.
- Results. In I group in comparison to II analysis revealed higher percentage of tumor grade G2-4, multifocality, and tumors of upper pole of the kidney. There was no statistically significant difference in death percentage and disease progression during significant shorter period of observations in I group. Excavation did not reveal in comparison to resection, statistically significance in oncologic results however percentage of patients with renal insufficiency was decreased. In above 40 percent of patients with medium and mild degree of renal insufficiency we observed it withdrawal after compensation period assisted with protective diet and /or pharmacotherapy.
- Conclusion. 1. Tumor excavation in patients with solitary kidney is procedure which increases nephrologic safety and gives similar oncologic radicality in comparison to parenchymal resection. 2. Poor prognosis factors are preoperative renal insufficiency, tumor over 4 cm diameter, multifocality, over 10 years period of living with solitary kidney, low differentiation of tumor cell, and tumor location in upper pole. 3. In above 40% of patients with medium and mild grade of renal insufficiency after NSS assisted compensative function increase of remnant renal parenchyma in solitary kidney. This leads to its normalization, decreasing the need of dializotherapy and improves patients quality of life.
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