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Organ- und Funktionserhalt beim Nierenzellkarzinom

Organ and kidney function preservation in renal cell carcinoma

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Zusammenfassung

Hintergrund

Die organerhaltende Nierentumorresektion hat sich zunehmend bei kleinen unilateralen Nierentumoren (< 4 cm) mit gesunder Gegenniere etabliert und in den letzten Jahren an Stellenwert gewonnen. Es hat sich gezeigt, dass die kardiovaskuläre Mortalitätsrate signifikant ansteigt und sich die Lebensqualität verschlechtert, je mehr intaktes Nierengewebe entfernt wird.

Fragestellung

In der vorliegenden Untersuchung wurden prä- und perioperative Einflussfaktoren auf den direkten postoperativen Verlauf, die 5-Jahres-Überlebensrate und das Rezidiv-Verhalten nach offener organerhaltender Nierentumorresektion im eigenen Kollektiv untersucht.

Material und Methoden

In dieser retrospektiven Untersuchung wurden 1657 Patienten erfasst, die zwischen den Jahren 2007 und 2013 in der Klinik für Urologie des Universitätsklinikums Essen wegen eines Nierentumors operiert wurden. 38 % dieser Operationen (n = 636) wurden organerhaltend durchgeführt. Es wurden Faktoren ermittelt, die sich auf Bluttransfusionsnotwendigkeit und Hospitalisierungsdauer bei organerhaltender Operation auswirken.

Ergebnisse

Für die Notwendigkeit einer Bluttransfusion lassen sich keine unabhängigen Parameter ermitteln. Die Tumorgröße und damit die Resektionsgröße beeinflusst nicht die Notwendigkeit einer Erythrozytengabe. Darüber hinaus hat die Tumorgröße weder auf den postoperativen Serumhämoglobingehalt noch auf die Höhe des Serumkreatininwertes einen Effekt. Von den nicht beeinflussbaren Faktoren bedingen ein höheres Patientenalter und weibliches Geschlecht eine längere Hospitalisierung. Als variable Größe kann die postoperative Schmerztherapie angesehen werden, die keinen Einfluss auf die Liegedauer hat. Beeinflussbaren Faktoren, welche die Gesamtliegedauer verlängern, sind jedoch die Art der unmittelbaren postoperativen Überwachung (Intensivstation vs. Wachzimmer) und die Gabe von Bluttransfusionen.

Schlussfolgerungen

Es gibt konstante Faktoren, bei denen im Rahmen einer organerhaltenden Nierentumorresektion mit einer längeren Verweildauer zu rechnen ist. Zudem spricht die Unabhängigkeit der Tumorgröße – neben nachgewiesenen guten onkologischen Ergebnissen – für eine Erweiterung der Indikation zur organerhaltenden Nierentumorresektion auf Tumoren > 4 cm.

Abstract

Background

The organ-preserving partial nephrectomy has increasingly established itself in small unilateral renal tumours (<4 cm) with contralateral healthy kidney and counter gained in recent years in importance. There was found a significantly increased cardiovascular mortality rate and deteriorated quality of life, the more intact kidney tissue has been removed.

Objectives

In the present study, the influence of pre- and perioperative factors on direct postoperative course was examined, including 5-year survival rate and relapse behaviour after open organ-preserving partial nephrectomy in our own collective.

Materials and methods

In this retrospective study of 1657 patients were collected, who underwent surgery between 2007 and 2013 in the Department of Urology at the University Hospital Essen because of a renal tumour. 38 % of these operations (n = 636) were performed organ-preserving. In this trial there are factors identified that have an impact on need of blood transfusion and length of hospitalization in organ-preserving operation method.

Results

No independent parameter can be determined for the need of blood transfusion. Tumour size and thus time of resection procedure does not affect the need of erythrocytes administration. In addition, the tumour size influences neither the postoperative serum-haemoglobin nor serum-creatinine. Increased patient age and female gender are identified as non-modifiable factors, which cause a longer hospitalisation. Postoperative pain therapy can be considered as a variable size, which does not affect the length of hospital stay. Modifiable factors that increase the overall length of stay, however, are the type of direct postoperative monitoring (ICU vs. anaesthetic recovery room) and the administration of blood transfusions.

Conclusions

There are constant factors, which can be associated with a longer residence time in the framework of an organ-preserving partial nephrectomy. Further there is shown evidence of the independence of the tumour size – in addition to proven good oncological results – of an extension of indication of organ-preserving nephrectomy of tumours > 4 cm.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Schenck, R. Eder, H. Rübben, C. Niedworok und S. Tschirdewahn geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltete keine Studien an Menschen oder Tieren.

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  1. Urologische Universitätsklinik Essen, Hufelandstraße 55, 45122, Essen, Deutschland

    M. Schenck, R. Eder, H. Rübben, C. Niedworok & S. Tschirdewahn

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  1. M. Schenck
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  2. R. Eder
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Schenck, M., Eder, R., Rübben, H. et al. Organ- und Funktionserhalt beim Nierenzellkarzinom. Urologe 53, 1329–1343 (2014). https://doi.org/10.1007/s00120-014-3558-5

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