The influence of surgical approach on the results of treatment of renal cell cancer
Article published in Urologia Polska 2007/60/4.

authors

Leszek Bortnowski, Henryk Zieliński, Grzegorz Piotrowicz: Klinika Urologii Wojskowego Instytutu Medycznego w Warszawie

keywords

kidney, renal cell cancer, surgical approach, complications, survival

summary

The aim of the study. The aim of this study is a retrospective comparison of survival and complications in patients after nephrectomy performed by transperitoneal and retroperitoneal approach.

Material and methods. Survival analysis was based on our own material. Only patients with clear cell cancer on pathologic examination

were included. In order to make comparable groups, patients were paired according to similar parameters of the disease and general status. In this manner the population of 510 patients was split in two nearly identical groups: transperitoneal approach (P = 256 patients) and retroperitoneal approach (L = 254 patients). Statistical analysis using Kaplan-Meier and Wilcoxon-Gehan method was performed.

Results. Analysis showed that survival of patients after transperitoneal and retroperitoneal nephrectomy was similar. Five-year and ten–year survival rates after transperitoneal nephrectomy were: for pT1 96% and 60% respectively, for pT2 83% and 35% respectively, for pT3a 80% and 0% respectively. After retroperitoneal nephrectomy the estimates of survival at 5 and 10 years were: for pT1 99% and 44% respectively, for pT2 – 90% and 26% respectively, for pT3a – 70% and 0% respectively. There was no significant difference in the number of complications for these two groups but they were of different type.

Conclusions. Analysis showed that both transperitoneal and retroperitoneal approach for patients with RCC (pT1, pT2, pT3a N0 M0) treated with nephrectomy provide similar survival rates. The survival prognosis depends on clinical stage and tumour diameter. There was no significant difference in the number of intra – and postoperative complications, however they were of different type.

references

Couillard D R, de Vere White RW: Surgery of renal cell carcinoma. Urol Clin Nor Am, 1993, 20, 263-275.
Dembowski J: Ocena kliniczna nefrektomii radykalnej w leczeniu raka nerki, rozprawa doktorska, Akademia Medyczna we Wrocławiu, Wrocław, 1985, 49-61.
Ditonno P, Saracino GA, Macchia M et al: Prospective randomized trial comparing lombotomic versus laparotomic access in the surgery of renal cell carcinoma. Br J Urol 1997, 80 (Suppl 2): 119.
Ditonno P, Traficante A, Battagria M et al: Role of lymphadenectomy in renal carcinoma. Prog Clin Res 1992, 378, 169-174.
Droler MJ: Anatomic considerations in extraperitoneal approach to radical nephrectomy. Urology 1990, 36, 118-123.
Eschwege P, Saussine C, Steichen G et al: Radical nephrectomy for renal cell carcinoma 30 mm, or less: long-term follow results: J Urol 1996, 155, 1196-1199.
Giuliani L, Glenn G, Martorana G, Rovida S: Radical extensive surgery for renal cell carcinoma: long-term results and prognostic factors. J Urol 1990, 143, 468-474.
Giuliani L, Giberti C, Martorana G, Rovida S: Radical extensive surgery for renal cell carcinoma: long-term results and prognostic factors. J Urol 1990, 143 (3), 468-473; discussion 473-474.
Giuliani L, Giberti C, Oneto F: Lymph node dissection in renal cell carcinoma.
Eur Urol Update Series, 1992, 1, 26-30.
Herranz Amo F, Verdu Tartajo F, Diez Cordero JM: Complications of radical nephrectomy in the treatment of kidney adenocarcinoma. Actas Urol Esp 1997, 21 (1), 15-21.
Jgarashi T, Tobe T, Nakatsu H-O et al: The impact of a 4cm cutoff point for stratification of T1N0M0 renal cell carcinoma after radical nephrectomy. J Urol 2001, 165, 1103-1106.
Kageyama Y, Fukui I, Goto S et al: Treatment results of radical nephrectomy
for relatively confined small renal cell carcinoma – translumbar versus transabdominal approach. Jap J Urol 1994, 85, 599-603.
Mejean A, Vogt B, Quazza JE et al: Mortality and morbidity after nephrectomy
for renal cell carcinoma using a transperitoneal anterior subcostal incision. EurUrol 1999, 36 (4), 298-302.
Nurmi MJ, Puntala PV, Tyrkko JE, Antila LA: Transabdominal and lumbar nephrectomy for renal adenocarcinoma. Scand J Urol Nephrol 19, 129-131, 1985.
Robson Ch: Radical nephrectomy for renal cell carcinoma/ J Urol, 1963, 89, 37.
Robson CJ, Churchill BM, Anderson W: The results of radical nephrectomy for renal cell carcinoma. J Urol 1969, 101, 297-301.
Scott Russell FJR, Selzman Harold M: Complications of nephrectomy: review of 450 patients and a description of a modification of the transperitoneal
approach. J Urology, 1966, Vol 95, 307-312.
Sene AP, Hunt L, Mc Mahon RF, Carroll RN: Renal carcinoma in patients undergoing nephrectomy: analysis of survival and prognostic factors. Br J Urol 1992, 70, 125-134.
Srigley J R, Hutter RVP, Gelb AB et al: Current prognostic factors + renal cell carcinoma. Cancer 1997, 80, 994-996.
Stachowiak W, Fleury J P, Camillieri L i in: Postępowanie chirurgiczne w leczeniu guzów nerek ze skrzepliną w żyle głównej dolnej. Urol Pol 1997, 50, 133-141.
Stolarczyk J: Nefrektomia radykalna (doniesienie wstępne). Urol Pol 1980, 33, 161-165.
Strösslein F, Schwenke A, Münster W et al: Verbesserung der Prognose Des Nierenzellkarzinoms durch perkutane transvasale embolisation. Z Urol Nephrol 1987, 80, 577-586.

correspondence