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Kontroversen der Nierenteilresektion bei Nierenzellkarzinom

Umfrage im deutschsprachigen Raum

Controversies of partial nephrectomy for renal cell carcinoma

Survey in the German-speaking countries

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Zusammenfassung

Hintergrund

Ziel dieser Studie war es zu evaluieren, wie in Deutschland, Österreich und der Schweiz die Nierenteilresektion technisch durchgeführt wird.

Material und Methoden

Es wurde ein einseitiger anonymer Fragebogen entworfen, um die Indikation, das technische Vorgehen und die Nachsorge bei R1-Resektion zur Nierenteilresektion abzufragen. Weiterhin wurden die Größe der Krankenhäuser und deren Einzugsgebiet erfasst. Der Fragebogen wurde an 341 urologische Kliniken verschickt und eine statistische Auswertung vorgenommen.

Ergebnisse

Die Rücklaufquote betrug 69 %. Bis zu 99 % der Kliniken führen die Teilresektion auch bei T1b-Tumoren durch. 58 % der Kliniken führen diesen Eingriff auch laparoskopisch durch. 83 % führen die Teilresektion auch in warmer Ischämie durch. Bei R1-Befund wird von 29 % eine Bildgebung innerhalb der ersten 6 Wochen empfohlen. Laut dieser Umfrage führten Kliniken der Maximalversorgung häufiger laparoskopische Nierenteilresektionen durch (p = 0,003).

Schlussfolgerung

Die Studie von 236 Kliniken welche Nierenteilresektionen durchführen zeigt eine große Variabilität bei Indikation, Technik und Nachsorge der organerhaltenden Nierentumorchirurgie. Sie zeigt auch, dass ein großer Teil der Tumore > 4 cm organerhaltend operiert werden, davon auch ein hoher Anteil minimal-invasiv. Die sehr unterschiedliche Handhabung bei positivem Schnellschnitt und R1-Befunden zeigt die Notwendigkeit weiterer Studien zum Langzeit-Follow-up nach minimal-invasiver Chirurgie bei R1- und Nierentumoren > T1a.

Abstract

Background

The goal of this study was to evaluate how partial nephrectomy is technically performed in Germany, Austria, and Switzerland.

Methods

A one-page anonymous questionnaire was designed to evaluate the indication, the technical procedure, and the follow-up of R1 situation after partial nephrectomy. Furthermore, the size of the hospitals and their catchment areas were recorded. The questionnaire was sent to 341 clinics and a statistical analysis was performed.

Results

The response rate was 69 %. Up to 99 % of the clinics also perform partial resection in T1b tumors. Of those responding, 58 % perform this surgery laparoscopically, and 83 % of the surgeries are performed in warm ischemia. For the follow-up, 29 % suggest imaging within the first 6 weeks. According to this survey, maximum care clinics perform laparoscopic nephrectomy more frequently (p = 0.003).

Conclusion

The survey of 236 hospitals performing partial nephrectomy shows great variability in the indication, technique, and aftercare of organ-preserving renal tumor surgery. It also shows that a large proportion of tumors >4 cm undergo organ-preserving surgery, many of them minimally invasive. The diverse handling with positive instantaneous section and R1 results suggest the need for further studies concerning long-term follow-up after minimally invasive surgery with R1 situation and renal tumors > T1a.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Tietze, M. Herms, W. Behrend, A. Hamza geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Urologie und Andrologie, Klinikum St. Georg gGmbH, Delitzscher Straße 141, 04129, Leipzig, Deutschland

    S. Tietze, M. Herms, W. Behrendt, J. Krause & A. Hamza

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  1. S. Tietze
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  2. M. Herms
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  3. W. Behrendt
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  4. J. Krause
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  5. A. Hamza
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Correspondence to S. Tietze.

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Tietze, S., Herms, M., Behrendt, W. et al. Kontroversen der Nierenteilresektion bei Nierenzellkarzinom. Urologe 53, 1181–1185 (2014). https://doi.org/10.1007/s00120-014-3469-5

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