Öz
Amaç:Böbrek
kanseri tüm ürolojik kanserler içerisinde 3. Sırada olmasına
rağmen mortalitesi en yüksek olanıdır. Görüntüleme
tekniklerinin artması ile görülme sıklığı artmaktadır.
Böbrek kitlelerinde parsiyel nefrektomi; radikal nefrektomi ile
eşit onkolojik sonuçlar göstermesi ile uygun renal kitlelerde
gereksiz organ kaybını önlemektedir. Biz bu çalışmamızda
kliğinimizde renal kitle nedenli yapılan açık parsiyel nefrektomi
(APN) sonuçlarımızı değerlendirmeyi amaçladık.
Materyal ve metod:Kliniğimizde
Ocak 2011- Temmuz 2017 yılları arasında renal kitle nedeni ile APN
yapılan hastaların dosyalarını geriye dönük olarak
değerlendirmeye aldık. Hastalarımızın tümör çapı,
hastanede kalış süresi, patoloji sonuçları, postoperatif
takiplerimizi değerlendirdik.
Bulgular: Kliniğimizde
toplam 132 hasta çalışmaya alındı. Yaş ortalaması 54 ± 1.2
yıldı ve bu hastaların 69’u erkek (%52.2),
63’ü kadındı (%43.8). Bu hastaların 64 (%48.4) tanesinin kitle
sol tarafında iken 68(%51.6) tanesinde sağ tarafta idi. Patoloji
sonuçlarında ise 132 hastanın 106 ‘sı (%79.1) renal hücreli
karsinom (RCC) , 12‘si (%8.9) anjiomyolipom, 5‘i (%3.7)
apse-kronik pyelonefrit, 5’i (%3.7) onkositoma, 3’ü (%2.2)
leomiyoma ve 1’i (%0.75) malign epitelyal tümör olarak
raporlandı. 3 (%2.2) hastada cerrahi sınır pozitif olarak
raporlandı. Ancak hiçbir hastanın takiplerinde lokal nüks veya
sistemik metastaz saptanmadı.
Sonuç: Böbrek
koruyucu cerrahide, hemoraji çok ciddi bir komplikasyondur.
Hemorajiyi engellemek için klasik yöntem olan geçici klemplemenin
yanında, parankim kompresyonunun da etkin ve güvenilir bir yöntem
olarak kullanılabileceğini düşünmekteyiz.
Anahtar Kelimeler
Kaynakça
- 1. European Network of Cancer Registries: Eurocim version 4.0. 2001: Lyon, France.
- 2. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer, 2013; 49(6): 1374-403.
- 3. Pichler M, Hutterer GC, Chromecki TF, Jesche J, Kampel-Kettner K, Eberhard K et al. Trends of stage, grade, histology and tumour necrosis in renal cell carcinoma in a European centre surgical series from 1984 to 2010. J Clin Pathol. 2012;65(8):721–4.
- 4. Clague J, Lin J, Cassidy A, Matin S, Tannir NM, Tamboli P et al. Family history and risk of renal cell carcinoma: results from a case-control study and systematic meta-analysis. Cancer Epidemiol Biomarkers Prev, 2009; 18(3): 801-7.
- 5. Mitterberger M, Pelzer A, Colleselli D, Bartsch G, Strasser H, Pallwein L et al. Contrast-enhanced ultrasound for diagnosis of prostate cancer and kidney lesions. Eur J Radiol. 2007;64(2):231-8.
- 6. Ljungberg B, Albiges L, Bensalah K, Bex A, Giles RH, Hora M et al. Guidelines Associates: Abu-Ghanem Y, Dabestani S, Fernandez-Pello Montes S, Hofmann F, Tahbaz R. http://uroweb.org/guideline/renal-cell-carcinoma/2018.
- 7. Kural AR, Demirkesen O, Onal B, Obek C, Tunc B, Onder AU et al. Outcome of nephron-sparing surgery: elective versus imperative indications. Urol Int 2003;71(2):190-6.
- 8. Lee JH, You CH, Min GE, Park JS, Lee SB, Ahn H et al. Comparison of the surgical outcome and renal function between radical and nephron-sparing surgery for renal cell carcinomas. Korean J Urol, 2007;48(7): 671-676.
- 9. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009; 182(2): 844-53.
- 10. Ficarra V, Novara G, Secco S, Macchi V, Porzionato A, De Caro R et al Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009; 56(5): 786-93
- 11. Simmons Mn, Ching CB, Samplaski MK, Park CH, Gill IS. Kidney tumor location measurement using C index method. J Urol. 2010; 183(5): 1708-13.
- 12. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.
- 13. Remzi M, Ozsoy M, Klingler HC, Susani M, Waldert M, Seitz C et al. Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter. J Urol. 2006; 176(3): 896-9.
- 14. Uzzo RG, Novick AC. Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol. 2001; 166(1):6-18.
- 15. Bhayani SB, Rha KH, Pinto PA, Ong AM, Allaf ME, Trock BJ et al. Laparoscopic partial nephrectomy: effect of warm ischemia on serum creatinine. J Urol. 2004 Oct;172(4 Pt 1):1264-6.
- 16. Gill IS, Abreu SC, Desai MM, Steinberg AP, Ramani AP, Ng C et al. Laparoscopic ice slush renal hypothermia for partial nephrectomy: the initial experience. J Urol. 2003;170(1):52-6.
- 17. Choi JE, You JH, Kim DK, Rha KH, Lee SH. Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol, 2015; 67(5): 891-901.
- 18. Steinestel J, Steffens S, Steinestel K, Schrader AJ. Positive surgical margins in nephron-sparing surgery: risk factors and therapeutic consequences. World J Surg Oncol, 2014;8;12:252.
- 19. Tabayoyong W, Abouassaly R, Kiechle JE, Cherullo EE, Meropol NJ, Shah ND, et al. Variation in Surgical Margin Status by Surgical Approach among Patients Undergoing Partial Nephrectomy for Small Renal Masses. J Urol. 2015; 194(6): 1548-53.
- .
Öz
Background: Kidney
cancer has the highest mortality in despite of being the 3rd most
common types of urological cancers. The increase in the number of
imaging techniques increases the rate of incidence. Partial
nephrectomy in renal masses demonstrates similar oncologic outcomes
with radical nephrectomy which preventing unnecessary organ loss in
appropriate renal masses. In this study, we aimed to evaluate our
results of open partial nephrectomy (OPN) in our clinic due to renal
mass.
Methods: We
retrospectively evaluated the files of patients who underwent open
partial nephrectomy for renal masses between January 2011 and July
2017 in our clinic. We assessed our patients' tumor size, duration of
hospital stay, pathology results, and postoperative follow-up.
Results: A
total of 132 patients were enrolled in the study. The mean age was 54
± 1.2 years and 69 of these patients were male (52.2%) and 63 were
female (43.8%). The mass was on the left side of 64 (48.4%) of these
patients and 68 (51.6%) on the right side. In pathology results, 106
(79.1%) renal cell carcinoma (RCC), 12 (8.9%) angiomyolipoma, 5
(3.7%) abscess-chronic pyelonephritis, 5 (3.7%) oncocytomas, 3 (2.2%)
leiomyomas, 1 (0.75%) malignant epithelial tumor were reported in 132
patients. 3 (2.2%) patients were reported to have positive surgical
margin. However no local recurrence or systemic metastasis was
detected in any of the patients.
Conclusions: In
nephron sparing surgery, haemorrhage is a very serious complication.
In our opinion, parenchymal compression can be used as an effective
and reliable method besides the temporary clamp, which is the
classical method to prevent hemorrhage.
Anahtar Kelimeler
Kaynakça
- 1. European Network of Cancer Registries: Eurocim version 4.0. 2001: Lyon, France.
- 2. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer, 2013; 49(6): 1374-403.
- 3. Pichler M, Hutterer GC, Chromecki TF, Jesche J, Kampel-Kettner K, Eberhard K et al. Trends of stage, grade, histology and tumour necrosis in renal cell carcinoma in a European centre surgical series from 1984 to 2010. J Clin Pathol. 2012;65(8):721–4.
- 4. Clague J, Lin J, Cassidy A, Matin S, Tannir NM, Tamboli P et al. Family history and risk of renal cell carcinoma: results from a case-control study and systematic meta-analysis. Cancer Epidemiol Biomarkers Prev, 2009; 18(3): 801-7.
- 5. Mitterberger M, Pelzer A, Colleselli D, Bartsch G, Strasser H, Pallwein L et al. Contrast-enhanced ultrasound for diagnosis of prostate cancer and kidney lesions. Eur J Radiol. 2007;64(2):231-8.
- 6. Ljungberg B, Albiges L, Bensalah K, Bex A, Giles RH, Hora M et al. Guidelines Associates: Abu-Ghanem Y, Dabestani S, Fernandez-Pello Montes S, Hofmann F, Tahbaz R. http://uroweb.org/guideline/renal-cell-carcinoma/2018.
- 7. Kural AR, Demirkesen O, Onal B, Obek C, Tunc B, Onder AU et al. Outcome of nephron-sparing surgery: elective versus imperative indications. Urol Int 2003;71(2):190-6.
- 8. Lee JH, You CH, Min GE, Park JS, Lee SB, Ahn H et al. Comparison of the surgical outcome and renal function between radical and nephron-sparing surgery for renal cell carcinomas. Korean J Urol, 2007;48(7): 671-676.
- 9. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009; 182(2): 844-53.
- 10. Ficarra V, Novara G, Secco S, Macchi V, Porzionato A, De Caro R et al Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009; 56(5): 786-93
- 11. Simmons Mn, Ching CB, Samplaski MK, Park CH, Gill IS. Kidney tumor location measurement using C index method. J Urol. 2010; 183(5): 1708-13.
- 12. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.
- 13. Remzi M, Ozsoy M, Klingler HC, Susani M, Waldert M, Seitz C et al. Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter. J Urol. 2006; 176(3): 896-9.
- 14. Uzzo RG, Novick AC. Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol. 2001; 166(1):6-18.
- 15. Bhayani SB, Rha KH, Pinto PA, Ong AM, Allaf ME, Trock BJ et al. Laparoscopic partial nephrectomy: effect of warm ischemia on serum creatinine. J Urol. 2004 Oct;172(4 Pt 1):1264-6.
- 16. Gill IS, Abreu SC, Desai MM, Steinberg AP, Ramani AP, Ng C et al. Laparoscopic ice slush renal hypothermia for partial nephrectomy: the initial experience. J Urol. 2003;170(1):52-6.
- 17. Choi JE, You JH, Kim DK, Rha KH, Lee SH. Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol, 2015; 67(5): 891-901.
- 18. Steinestel J, Steffens S, Steinestel K, Schrader AJ. Positive surgical margins in nephron-sparing surgery: risk factors and therapeutic consequences. World J Surg Oncol, 2014;8;12:252.
- 19. Tabayoyong W, Abouassaly R, Kiechle JE, Cherullo EE, Meropol NJ, Shah ND, et al. Variation in Surgical Margin Status by Surgical Approach among Patients Undergoing Partial Nephrectomy for Small Renal Masses. J Urol. 2015; 194(6): 1548-53.
- .
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 22 Mart 2019 |
| Gönderilme Tarihi | 29 Aralık 2018 |
| Kabul Tarihi | 25 Şubat 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 16 Sayı: 1 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty