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Wann organerhaltende Tumorresektion, wann Tumornephrektomie beim Nierenzellkarzinom?

When to perform partial nephrectomy and when to opt for total nephrectomy in renal cell carcinoma?

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Die Onkologie Aims and scope

Zusammenfassung

Hintergrund

Der chirurgische Goldstandard in der Therapie des Nierenzellkarzinoms stellt die partielle Nephrektomie (pNx) bzw. totale Nephrektomie/Tumornephrektomie (TNx) dar.

Ziel

Der vorliegende Artikel beleuchtet die beiden Operationsmethoden und stellt die Datenlage zur Selektion des geeigneten Verfahrens vor.

Material und Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema pNx und TNx beim Nierenzellkarzinom sowie einer Auswertung der aktuellen europäischen und US-amerikanischen Leitlinien zur operativen Therapie des Nierenzellkarzinoms.

Ergebnisse

Neben der Konfiguration des Nierentumors bestimmen insbesondere die Komorbiditäten der Patienten die Wahl des operativen Verfahrens. Während die pNx bei kleineren, lokal begrenzten Tumoren Anwendung findet, ist die TNx bei größeren und komplexeren Tumoren sowie bei der Operation bei lokal fortgeschrittenen (z. B. bei venösem Tumorzapfen) und metastasierten Tumorstadien meist die Methode der Wahl. Beide Op.-Verfahren können dabei minimal-invasiv (laparoskopisch bzw. roboterassistiert) und offen chirurgisch erfolgen.

Abstract

Background

Both partial nephrectomy (pNx) and total nephrectomy (TNx) are the mainstay of surgical treatment of renal cell carcinoma.

Aim

This article will provide a closer look at both surgical methods and the current evidence to support their use.

Materials and methods

This study is based on a selective literature review regarding partial nephrectomy and total nephrectomy for renal cell carcinoma using the PubMed database and the review of current European and American guidelines on surgical treatment of renal cell carcinoma.

Results

Choice of surgical method depends on intrarenal tumor configuration and patient comorbidities. While pNx is used for smaller, localized masses, TNx is usually performed in larger, more complex tumors as well as for surgery of locally advanced cases (e.g., if a venous tumor thrombus is present) and for cytoreductive surgery in metastatic disease. Both methods can be performed using a minimally invasive (laparoscopic or robotic) or an open approach.

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Literatur

  1. Herr HW (2008) Surgical management of renal tumors: a historical perspective. Urol Clin North Am 35(4):543–549

    Article  PubMed  Google Scholar 

  2. Heidenreich A,  European Society of Oncological Urology (2004) Preoperative imaging in renal cell cancer. World J Urol 22(5):307–315

    Article  PubMed  Google Scholar 

  3. Keane TE, Graham SD Jr. et al (Hrsg) (2016) Glenn’s urologic surgery, 8. Aufl. Wolters Kluwer, Philadelphia, PA, USA

    Google Scholar 

  4. Würnschimmel C et al (2020) Robot-assisted Laparoscopic partial nephrectomy vs conventional laparoscopic partial nephrectomy: functional and surgical outcomes of a prospective single surgeon randomized study. J Endourol 34(8):847–855

    Article  PubMed  Google Scholar 

  5. Sun Y et al (2021) Intraoperative ultrasound: technique and clinical experience in robotic-assisted renal partial nephrectomy for endophytic renal tumors. Int Urol Nephrol 53(3):455–463

    Article  PubMed  Google Scholar 

  6. Crestani A et al (2016) Introduction to small renal tumours and prognostic indicators. int J Surg 36(Pt C):495–503

    Article  PubMed  Google Scholar 

  7. Hemal AK et al (2007) Laparoscopic versus open radical nephrectomy for large renal tumors: a long-term prospective comparison. J Urol 177:862

    Article  CAS  PubMed  Google Scholar 

  8. Brewer K et al (2012) Perioperative and renal function outcomes of minimally invasive partial nephrectomy for T1b and T2a kidney tumors. J Endourol 26:244

    Article  PubMed  Google Scholar 

  9. Chang KD et al (2018) Functional and oncological outcomes of open, laparoscopic and robot-assisted partial nephrectomy: a multicentre comparative matched-pair analyses with a median of 5 years’ follow-up. BJU Int 122:618

    Article  PubMed  Google Scholar 

  10. Luzzago S et al (2021) Contemporary rates and predictors of open conversion during minimally invasive partial nephrectomy for kidney cancer. Surg Oncol 36:131–137

    Article  PubMed  Google Scholar 

  11. Arora S et al (2018) What is the hospital volume threshold to optimize inpatient complication rate after partial nephrectomy? Urol Oncol 36(339):e17

    Google Scholar 

  12. Ljungberg B et al (2022) European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 Update. Eur Urol 82(4):399–410

    Article  PubMed  Google Scholar 

  13. Van Poppel H et al (2011) A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 59:543

    Article  PubMed  Google Scholar 

  14. Kates M et al (2011) Increased risk of overall and cardiovascular mortality after radical nephrectomy for renal cell carcinoma 2 cm or less. J Urol 186:1247

    Article  PubMed  Google Scholar 

  15. Silagy A et al (2021) Predictors of long-term renal function after kidney surgery for patients with preoperative chronic kidney disease. Can Urol Assoc J 15(2):E103–E109

    PubMed  Google Scholar 

  16. Van Poppel H et al (2007) A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 51:1606

    Article  PubMed  Google Scholar 

  17. Campbell SC et al (2021) Renal mass and localized renal cancer: evaluation, management, and follow-up: AUA guideline part I. J Urol 206:199

    Article  PubMed  Google Scholar 

  18. Janssen MWW et al (2018) Survival outcomes in patients with large (〉/=7 cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: results of a multicenter cohort with long-term follow-up. PLoS ONE 13:e196427

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Robson CJ et al (1969) The results of radical nephrectomy for renal cell carcinoma. j Urol 101(3):297–301

    Article  CAS  PubMed  Google Scholar 

  20. Capitanio U et al (2014) Extent of lymph node dissection at nephrectomy affects cancer-specific survival and metastatic progression in specific sub-categories of patients with renal cell carcinoma (RCC). BJU Int 114:210

    Article  PubMed  Google Scholar 

  21. Gershman B et al (2018) Radical nephrectomy with or without lymph node dissection for high risk nonmetastatic renal cell carcinoma: a multi-institutional analysis. J Urol 199:1143

    Article  PubMed  Google Scholar 

  22. Liu H et al (2021) A meta-analysis for comparison of partial nephrectomy in patients with pT3a renal cell carcinoma. Transl Androl Urol 10839:1170–1178

    Article  Google Scholar 

  23. Vergho DC et al (2012) Tumor thrombus of inferior vena cava in patients with renal cell carcinoma—clinical and oncological outcome of 50 patients after surgery. bmc Res Notes 1;5:5

    PubMed  Google Scholar 

  24. Neves RJ, Zincke H (1987) Surgical treatment of renal cancer with vena cava extension. Br J Urol 59(5):390–395

    Article  CAS  PubMed  Google Scholar 

  25. Liu Z et al (2021) Completely laparoscopic versus open radical nephrectomy and infrahepatic tumor thrombectomy: comparison of surgical complexity and prognosis. Asian J Surg 44:641

    Article  PubMed  Google Scholar 

  26. Shemshaki H et al (2022) Comparison of cytoreductive partial versus radical nephrectomy in metastatic renal cell carcinoma: To be on the horns of a dilemma. Urologia 89(2):160–166

    Article  PubMed  Google Scholar 

  27. Motzer RJ et al (2002) Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. j Clin Oncol 1;20(1):289–296

    Article  PubMed  Google Scholar 

  28. Heng DY et al (2009) Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol 27:5794

    Article  CAS  PubMed  Google Scholar 

  29. Méjean A et al (2018) Sunitinib Alone or after Nephrectomy in Metastatic Renal-Cell Carcinoma. n Engl J Med 2;379(5):417–427

    Article  Google Scholar 

  30. Bex A et al (2019) Comparison of immediate vs deferred cytoreductive nephrectomy in patients with synchronous metastatic renal cell carcinoma receiving sunitinib: the SURTIME randomized clinical trial. JAMA Oncol 5:164

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Urologische Klinik und Poliklinik, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland

    Julian Marcon

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  1. Julian Marcon
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Correspondence to Julian Marcon.

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J. Marcon gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Marcon, J. Wann organerhaltende Tumorresektion, wann Tumornephrektomie beim Nierenzellkarzinom?. Onkologie 29, 599–605 (2023). https://doi.org/10.1007/s00761-023-01306-z

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  • DOI: https://doi.org/10.1007/s00761-023-01306-z

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