Advertisement

Der Urologe

, Volume 53, Issue 8, pp 1181–1185 | Cite as

Kontroversen der Nierenteilresektion bei Nierenzellkarzinom

Umfrage im deutschsprachigen Raum
  • S. TietzeEmail author
  • M. Herms
  • W. Behrendt
  • J. Krause
  • A. Hamza
Originalien

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.

Schlüsselwörter

Nierenteilresektion, laparoskopische Nierentumorchirurgie Chirurgie, minimal-invasive Nierenfunktion Niereninsuffizienz 

Controversies of partial nephrectomy for renal cell carcinoma

Survey in the German-speaking countries

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.

Keywords

Partial nephrectomy, laparoscopic Kidney neoplasms Surgical procedures, minimally invasive Kidney function Renal insufficiency 

Notes

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.

Literatur

  1. 1.
    Becker F, Van Poppel H, Hakenberg OW et al (2009) Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol 56:625–634PubMedCrossRefGoogle Scholar
  2. 2.
    Breda A, Stepanian SV, Lam JS et al (2007) Use of haemostatic agents and glues during laparoscopic partial nephrectomy: a multi-institutional survey from the United States and Europe of 1347 cases. Eur Urol 52:798–803PubMedCrossRefGoogle Scholar
  3. 3.
    Buethe DD, Moussly S, Lin HY et al (2012) Is the R.E.N.A.L. nephrometry scoring system predictive of the functional efficacy of nephron sparing surgery in the solitary kidney? J Urol 188:729–735PubMedCrossRefGoogle Scholar
  4. 4.
    Buffi N, Lista G, Larcher A et al (2012) Margin, ischemia, and complications (MIC) score in partial nephrectomy: a new system for evaluating achievement of optimal outcomes in nephron-sparing surgery. Eur Urol 62:617–618PubMedCrossRefGoogle Scholar
  5. 5.
    Butler BP, Novick AC, Miller DP et al (1995) Management of small unilateral renal cell carcinomas: radical versus nephron-sparing surgery. Urology 45:34–40PubMedCrossRefGoogle Scholar
  6. 6.
    Colli J, Sartor O, Grossman L et al (2012) Underutilization of partial nephrectomy for stage T1 renal cell carcinoma in the United States, trends from 2000 to 2008. A long way to go. Clin Genitourin Cancer 10:219–224PubMedGoogle Scholar
  7. 7.
    Desai PJ, Andrews PE, Ferrigni RG et al (2008) Laparoscopic partial nephrectomy at the Mayo Clinic Arizona: follow-up surveillance of positive margin disease. Urology 71:283–286PubMedCrossRefGoogle Scholar
  8. 8.
    Duvdevani M, Laufer M, Kastin A et al (2005) Is frozen section analysis in nephron sparing surgery necessary? A clinicopathological study of 301 cases. J Urol 173:385–387PubMedCrossRefGoogle Scholar
  9. 9.
    Gill IS, Ramani AP, Spaliviero M et al (2005) Improved hemostasis during laparoscopic partial nephrectomy using gelatin matrix thrombin sealant. Urology 65:463–466PubMedCrossRefGoogle Scholar
  10. 10.
    Greco F, Autorino R, Rha KH et al (2013) Laparoendoscopic single-site partial nephrectomy: a multi-institutional outcome analysis. Eur Urol 64:314–322PubMedCrossRefGoogle Scholar
  11. 11.
    Hagemann IS, Lewis JS Jr (2009) A retrospective comparison of 2 methods of intraoperative margin evaluation during partial nephrectomy. J Urol 181:500–505PubMedCrossRefGoogle Scholar
  12. 12.
    Hughes-Hallett A, Patki P, Patel N et al (2013) Robot-assisted partial nephrectomy: a comparison of the transperitoneal and retroperitoneal approaches. J Endourol 27:869–874PubMedCrossRefGoogle Scholar
  13. 13.
    Kim SP, Thompson RH (2013) Kidney function after partial nephrectomy: current thinking. Curr Opin Urol 23:105–111PubMedCrossRefGoogle Scholar
  14. 14.
    Lane BR, Campbell SC, Gill IS (2013) 10-year oncologic outcomes after laparoscopic and open partial nephrectomy. J Urol 190:44–49PubMedCrossRefGoogle Scholar
  15. 15.
    Lang H, Mouracade P, Gimel P et al (2013) National prospective study on the use of local haemostatic agents during partial nephrectomy. BJU Int doi: 10.1111/bju.12397Google Scholar
  16. 16.
    Li Q, Guan H, Qin J et al (2010) Mini-Margin nephron sparing surgery for renal cell carcinoma 4 cm or less. Adv Urol (Epub ahead of print). doi: 10.1155/2010/145942Google Scholar
  17. 17.
    Maclennan S, Imamura M, Lapitan MC et al (2012) Systematic review of oncological outcomes following surgical management of localised renal cancer. Eur Urol 61:972–993PubMedCrossRefGoogle Scholar
  18. 18.
    Marszalek M, Carini M, Chlosta P et al (2012) Positive surgical margins after nephron-sparing surgery. Eur Urol 61:757–763PubMedCrossRefGoogle Scholar
  19. 19.
    Nakano E, Fujioka H, Matsuda M et al (1984) Late recurrence of renal cell carcinoma after nephrectomy. Eur Urol 10:347–349PubMedGoogle Scholar
  20. 20.
    Pantuck AJ, Zisman A, Belldegrun AS (2001) The changing natural history of renal cell carcinoma. J Urol 166:1611–1623PubMedCrossRefGoogle Scholar
  21. 21.
    Ramani AP, Desai MM, Steinberg AP et al (2005) Complications of laparoscopic partial nephrectomy in 200 cases. J Urol 173:42–47PubMedCrossRefGoogle Scholar
  22. 22.
    Richter F, Schnorr D, Deger S et al (2003) Improvement of hemostasis in open and laparoscopically performed partial nephrectomy using a gelatin matrix-thrombin tissue sealant (FloSeal). Urology 61:73–77PubMedCrossRefGoogle Scholar
  23. 23.
    Schone G (1953) Vincenz Czerny, professor of surgery in Freiburg and Heidelberg and his contribution to the progress in surgery and gynecology. Bruns Beitr Klin Chir 187:385–408PubMedGoogle Scholar
  24. 24.
    Simmons MN, Weight CJ, Gill IS (2009) Laparoscopic radical versus partial nephrectomy for tumors > 4 cm: intermediate-term oncologic and functional outcomes. Urology 73:1077–1082PubMedCrossRefGoogle Scholar
  25. 25.
    Sun M, Trinh QD, Bianchi M et al (2012) A non-cancer-related survival benefit is associated with partial nephrectomy. Eur Urol 61:725–731PubMedCrossRefGoogle Scholar
  26. 26.
    Sundaram V, Figenshau RS, Roytman TM et al (2011) Positive margin during partial nephrectomy: does cancer remain in the renal remnant? Urology 77:1400–1403PubMedCrossRefGoogle Scholar
  27. 27.
    Mentzer JT, Flint DJ (1997) Validity in logistics research. J Bus Logist 18:199–216Google Scholar
  28. 28.
    Tanaka K, Shigemura K, Furukawa J et al (2013) Comparison of the transperitoneal and retroperitoneal approach in robot-assisted partial nephrectomy in an initial case series in Japan. J Endourol 27(11):1384–1388PubMedCrossRefGoogle Scholar
  29. 29.
    Van Poppel H, Becker F, Cadeddu JA et al (2011) Treatment of localised renal cell carcinoma. Eur Urol 60:662–672CrossRefGoogle Scholar
  30. 30.
    Weight CJ, Larson BT, Gao T et al (2010) Elective partial nephrectomy in patients with clinical T1b renal tumors is associated with improved overall survival. Urology 76:631–637PubMedCrossRefGoogle Scholar
  31. 31.
    Zini L, Patard JJ, Capitanio U et al (2009) Cancer-specific and non-cancer-related mortality rates in European patients with T1a and T1b renal cell carcinoma. BJU Int 103:894–898PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • S. Tietze
    • 1
    Email author
  • M. Herms
    • 1
  • W. Behrendt
    • 1
  • J. Krause
    • 1
  • A. Hamza
    • 1
  1. 1.Klinik für Urologie und AndrologieKlinikum St. Georg gGmbHLeipzigDeutschland

Personalised recommendations