T1 renal kitlelerde açık nefron koruyucu tedavi: Cerrahi, onkolojik ve fonksiyonel sonuçlarımız

Year 2013, Volume: 8 Issue: 3, 56 - 60, 01.08.2013

Ömer Turangezli Şenol Adanur Tevfik Ziypak Hasan Rıza Aydın Turgut Yapanoğlu Özkan Polat

Abstract

Amaç: Böbrek kitlesi tanısı ile T1 klinik evrede olan hastalara uyguladığımız nefron koruyucu cerrahinin cerrahi, onkolojik ve fonksiyonel sonuçlarını sunmayı amaçladık.Gereç ve Yöntemler: 2004 - 2012 tarihleri arasında 7 cm den küçük renal kitle tespit edilip açık nefron koruyucu cerrahi yapılan toplam 36 hasta çalışmamıza dahil edildi. Olguların demografik verileri, lezyonların radyolojik ve patolojik özellikleri ve takip süreleri retrospektif olarak değerlendirildi. Postoperatif takipte lokal nüksü değerlendirmek amacıyla alt üst batın magnetik rezonans görüntüleme metodu kullanıldı.Bulgular: Ortalama yaşları 54 yıl olan 19’u kadın 17’si erkek toplam 36 hastaya açık cerrahi teknik ile retroperitoneal NKC uygulandı. Ortalama tümor çapı 2.9x2.5 cm olarak tesbit edildi. Hastaların 3 %8 ’ünde bilateral renal kitle mevcuttu. iki hastaya operasyon esnasında sıcak iskemi uygulandı. Diğer hastalarda prosedür iskemisiz uygulandı. Hastaların preoperatif kreatinin değerleri ortalaması 0.87 mg/dl iken postoperatif kreatinin değerleri ortalaması 0.96 mg/dl olarak bulundu. Postoperatif kreatinin değerlerindeki artış istatistiksel olarak anlamlı bulunmadı p=0.81 . Sıcak iskemi yapılan 2 hastada da postoperatif kreatinin değerlerinde yükselme izlenmedi.Ortalama takip süresi 39 ay idi. Hiçbir hastada lokal nüks veya uzak metastaz izlenmedi. Hastalığa özgü sağ kalım ve genel sağ kalım oranları %100 olarak tesbit edildi.Sonuç: Açık parsiyel nefrektomi halen en sık olarak uygulanan nefron koruyucu tedavi yöntemidir. Radikal nefrektomi ile benzer onkolojik sonuçlar ve daha az kronik böbrek hastalığı gelişme riski ile uygun klinik evredeki böbrek tümörlerinde güvenle uygulanabilen bir yöntem olarak yerini korumaktadır

Keywords

Nefron koruyucu tedavi , Renal kitle

Open nephron-sparing treatment of T1 renal masses: Surgical, oncologic and functional outcomes

Abstract

Objective: We aimed to present surgical, oncological, and functional outcomes. We aimed to present surgical, oncological and functional outcomes of patients with T1 stage renal tumour which were treated with nephron-sparing surgery.Materials and Methods: A total of 36 patients who had undergone nephron-sparing surgery NSS between 2004, and 2012 for the management of previously identified renal masses of < 7 cm were included in our study. Demographic data, radiological, and histopathological characteristics of the cases, and the follow-up periods were retrospectively evaluated. During postoperative follow-up period whole abdomen was scanned with magnetic resonance imaging technique so as to evaluate local recurrences. Results: We performed retroperitoneal NSS using open technique on a total of 36 patients 19 women, and 17 men with a median age of 54 years range, 23-88 yrs . Mean diameter of the tumours was detected to be 2.9x2.5 cm. Three 8 % patients had bilateral renal masses. Warm ischemia had been used intraoperatively for 2 patients, and for the remaining patients this procedure was achieved without ischemia. Median pre- and postoperative creatinine values were 0.87, and 0.96 mg/dl, respectively. Increase in postoperative creatinine values were not found to be statistically significant p=0.81 . Any increase in postoperative creatinine values was not observed in 2 patients who had been operated under warm ischemia. Median follow-up period was 39 months 8-92 mos . Local recurrence or distant metastasis was not observed in any patient. Disease –specific, and overall survival rates were similar, and detected as 100 percent. Conclusion: Currently, open partial nephrectomy is the most frequently employed method of nephron-sparing surgery. It retains its place as a safely performed modality to be used in the management of renal tumours with proper indications, and oncological results similar to those of radical nephrectomy, but lesser risk of development of chronic renal disease

Keywords

Nephron sparing surgery , Renal

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