Evaluation of the Surgical Treatment Results of Kidney Cancer Central and Transmural Localization
1Radiology, A.V. Vishnevsky National Medical Research Center of Surgery, Russia
2Radiology, I.M. Sechenov First Moscow State Medical University, Russia
3Urology, A.V. Vishnevsky National Medical Research Center of Surgery, Russia
OBJECTIVE: to evaluate the results of surgical treatment of patients with kidney cancer central and transmural localization with ultrasound (US).
MATERIALS AND METHODS: Retrospective study included 84 patients with kidney tumors central and transmural localization, 45 (53.6%) men and 39 (46.4%) women aged 28 to 83 years. All patients underwent US in B-mode and duplex scanning at the stages: preoperative, intraoperatively, postoperative. All patients were operated on with morphological verification: clear-cell cancer - 68 (80.9%); papillary cancer - 7 (8.3%); juxtaglomerular tumor - 1 (1.2%); chromophobic cancer - 4 (4.8%); oncocytoma - 4 (4.8%). Depending on the tumor size patients were divided into five groups:
Group I (extracorporeal resection of the kidney with orthotopic vascular replantation without ureteral intersection) - 13 (15.5%) patients (average size 45 mm);
Group II (robot-assisted kidney resections) - 5 (5.9%) patients (average size 27 mm);
Group III (kidney resections) - 50 (59.5%) patients (average size 37 mm);
Group IV (nephrectomy) - 12 (14.3%) patients (average size 62 mm);
V group (RFA) - 4 (4.8%) of the patient (average tumor size is 24 mm).
RESULTS: Depending on the method of operative intervention the following results were obtained according to US in the postoperative period:
Group I: hematomas - 4 (30,8%), sizes 7-30 mm, fluid clusters - 4 (30,8%), sizes 5-98 mm. There weren’t complications in 5 (38.5%) patients.
Group II: hematomas - 3 (60,0%), sizes 25-30 mm. There weren’t complications in 2 (40.0%) patients.
Group III: hematomas - 13 (26.0%), sizes 21-62 mm, fluid clusters - 12 (24.0%), sizes 18-77 mm. There weren’t complications in 25 (50.0%) patients.
Group IV: hematomas - 2 (16,7%), sizes 26-36 mm, fluid clusters - 3 (25,0%), sizes 38-74 mm. There weren’t complications in 7 (58.3%) patients.
Group V: hematomas - 1 (25.0%), up to 15 mm in size. There weren’t complications in 1 (25.0%) patient.
CONCLUSIONS: Сеntral and transmural localization in combination with a significant size of the kidney tumor, often, is a limiting factor in choosing the method of surgical treatment of the patient. Resection of the kidney is the preferred method of treating such patients, allowing radical surgery to be performed while maintaining the organ. Extracorporeal resection of the kidney with orthotopic vascular replantation without crossing the ureter allows surgical intervention with large tumor sizes, the number of postoperative complications (hematomas and fluid clusters in the operative intervention zone) is comparable with kidney resection.