Advertisement

Quelle stratégie chirurgicale dans les cancers du rein localement avancés?

  • Hervé Lang
  • Didier Jacqmin
  • Catherine Roy
  • Frédéric Fernandez
  • Bernard Wagner
  • Pascal Mouracadé
Chapter
  • 335 Downloads
Part of the Oncologie pratique book series (ONCOLPRAT)

Abstrait

Le cancer du rein localement avancé regroupe ľensemble des cancers qui sont ni localisés intracapsulaires (pTl, pT2), ni métastatiques (M+). Le traitement de référence du cancer du rein est la chirurgie. Le but sera donc de proposer ľexérèse la plus large possible afin de retirer ľensemble de la masse tumorale, aucun traitement complémentaire n'étant à ce jour actif sur les reliquats tumoraux. Dans ce groupe de cancers du rein localement avancés, il convient de distinguer les cas où la chirurgie est réalisée en intention de traitement curatif, des cas où cette notion est plus aléatoire, voire impossible. Schématiquement, la frontière semble être représentée par le fascia de Gérota, plan de clivage essentiel de la néphrectomie totale élargie. Nous distinguons donc les tumeurs n'ayant pas franchi cette barrière et devant être retirées en totalité si ľexérèse est conduite de manière satisfaisante selon les principes oncologiques de la néphrectomie totale élargie (pT3a, b, c N0, MO) des tumeurs ayant dépassé ce fascia et dont ľexérèse sera fonction de critères peropératoires plus aléatoires sur ľextension de ľexérèse (pT4, pN+).

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Références

  1. 1.
    Kallmann DA, King BF, Hattery RR et al. (1992) Renal vein and inferior vena cava tumor thrombus in renal cell carcinoma: CT, US, MRI and venocavography. J Comput Assist Tomogr 96: 240–7CrossRefGoogle Scholar
  2. 2.
    Pozzi-Mucelli R, Rimondini A, Morra A (2004) Radiologic evaluation in planning surgery of renal tumors. Abdom Imaging 29: 312–9PubMedCrossRefGoogle Scholar
  3. 3.
    Sheth S, Scatarige JC, Horton KM et al. (2001) Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector CT and three-dimensional CT. Radiographics 21: S237–54Google Scholar
  4. 4.
    Pretorius ES, Wickstrom ML, Siegelman ES (2000) MR imaging of renal neoplasm. Magn Reson Imaging Clin North Am 8: 813–36Google Scholar
  5. 5.
    Roy C, El Ghali S, Buy X et al. (2005) Significance of the pseudocapsule on MR imaging of renal neoplasms and its potential application for local staging — A retrospective study. AJR Am J Roentgenol 184: 113–20PubMedGoogle Scholar
  6. 6.
    Siddiqui SA, Frank I, Leibovich BC et al. (2007) Impact of tumor size on the predictive ability of the pT3a primary tumor classification for renal cell carcinoma. J Urol 177: 59–62PubMedCrossRefGoogle Scholar
  7. 7.
    Hafez KS, Novick AC, Campbell SC (1997) Patterns of tumor recurrence and guidelines for followup after nephron sparing surgery for sporadic renal cell carcinoma. J Urol 157: 2067–70PubMedCrossRefGoogle Scholar
  8. 8.
    Lam JS, Belldegrun AS, Pantuck AJ (2006) Long-term outcomes of the surgical management of renal cell carcinoma. World J Urol 24: 255–66PubMedCrossRefGoogle Scholar
  9. 9.
    Cohen DD, Matin SF, Steinberg JR et al. (2005) Evaluation of the intact specimen after laparoscopic radical nephrectomy for clinically localized renal cell carcinoma identifies a subset of patients at increased risk for recurrence. J Urol 173: 1487–90PubMedCrossRefGoogle Scholar
  10. 10.
    Portis AJ, Yan Y, Landman J et al. (2002) Long term follow up after laparoscopic radical nephrectomy. J Urol 167: 1257–62PubMedCrossRefGoogle Scholar
  11. 11.
    Permpongkosol S, Chan DY, Link RE et al. (2005) Long-term survival analysis after laparoscopic radical nephrectomy. J Urol 174: 1222–5PubMedCrossRefGoogle Scholar
  12. 12.
    Chan DY, Cadeddu JA, Jarrett TW et al. (2001) Laparoscopic radical nephrectomy: cancer control for renal cell carcinoma. J Urol 166: 2095–100PubMedCrossRefGoogle Scholar
  13. 13.
    Fentie DD, Barrett PH, Taranger LA (2000) Metastatic renal cell cancer after laparoscopic radical nephrectomy: long-term follow-up. J Endourol 14: 407–11PubMedCrossRefGoogle Scholar
  14. 14.
    Iwamura M, Tsumura H, Matsuda D et al. (2004) Port site recurrence of renal cell carcinoma following retroperitoneoscopic radical nephrectomy with manual extraction without using entrapment sac or wound protector. J Urol 171: 1234–5PubMedCrossRefGoogle Scholar
  15. 15.
    Hallscheidt P, Fink Ch, Haferkamp A et al. (2005) Preoperative staging of renal cell carcinoma with inferior vena cava thrombus using multidetector CT and MRI: prospective study with histopathological correlation. J Comput Assist Tomogr 29: 1–13CrossRefGoogle Scholar
  16. 16.
    Lawrentschuk N, Gani J, Riordan R et al. (2005) Multidetector computed tomography vs magnetic resonance imaging for defining the upper limit of tumour thrombus in renal cell carcinoma: a study and review. BJU Int 96: 291–5PubMedCrossRefGoogle Scholar
  17. 17.
    Tuite DJ, Goeghegan T, McCauley G et al. (2006) Three-dimensional gadolinium-enhanced magnetic resonance breathhold FLASH imaging in the diagnosis and staging for renal cell carcinoma. Clin Radiol 61: 23–30PubMedCrossRefGoogle Scholar
  18. 18.
    Leibovitch I, Raviv G, Mor Y et al. (1995) Reconsidering the necessity of ipsilateral adrenalectomy during radical nephrectomy for renal cell carcinoma. Urology 46: 316–20PubMedCrossRefGoogle Scholar
  19. 19.
    Tsui KH, Shvarts O, Barbaric Z et al. (2000) Is adrenalectomy a necessary component of radical nephrectomy? UCLA experience with 511 radical nephrectomies. J Urol 163: 437–41PubMedCrossRefGoogle Scholar
  20. 20.
    Paul R, Mordhorst J, Leyh H, Hartung R (2001) Incidence and outcome of patients with adrenal metastases of renal cell cancer. Urology 57: 878–82PubMedCrossRefGoogle Scholar
  21. 21.
    Méjean A, André M, Doublet JD et al. (2004) Recommandations tumeurs du rein 2004. Prog Urol 14: 997–1035PubMedGoogle Scholar
  22. 22.
    Campbell SC, Novick AC, Bukowski RM (2007) Treatment of locally advanced renal cell carcinoma. In: Campbell-Walsh Urology volume 2 Saunders Elsevier, Philadelphia, p 1619–22Google Scholar
  23. 23.
    Hatcher PA, Anderson EE, Paulson DF et al. (1991) Surgical management and prognosis of renal cell carcinoma invading the vena cava. J Urol 145: 20–4PubMedGoogle Scholar
  24. 24.
    Margulis V, Sanchez-Ortiz R, Tamboli P et al. (2007) Renal cell carcinoma clinically involving adjacent organs: experience with aggressive surgical management. Cancer 109: 2025–30PubMedCrossRefGoogle Scholar
  25. 25.
    Joslyn SA, Sirintrapun SJ, Koneth BR (2005) Impact of lymphadenectomy and nodal burden in renal cell carcinoma: retrospective analysis of the national surveillance, epidemiology, and end results database. Urology 65: 675–680PubMedCrossRefGoogle Scholar
  26. 26.
    Coulange C, Rambeaud JJ (1997) Cancer du rein de ľadulte. Prog Urol 7: 733–909Google Scholar
  27. 27.
    Lang H, Jacqmin D (1997) Envahissement cave au cours des cancers du rein: technique et tactique chirurgicales. Encycl Med Chir (Elsevier SAS, Paris), Techniques chirurgicales, Urologie, 41-020: 1–5Google Scholar
  28. 28.
    Ciancio G, Livingstone AS, Soloway M (2007) Surgical management of renal cell carcinoma with tumor thrombus in the renal and inferior vena cava: the university of miamy experience in using liver transplantation techniques. Eur Urol 51: 988–95PubMedCrossRefGoogle Scholar
  29. 29.
    Novick AC, Cosgrove DM (1980) Surgical approach for removal of renal cell carcinoma extending into the vena cava and the right atrium. J Urol 123: 947–50PubMedGoogle Scholar
  30. 30.
    Marshall F, Dietrick D, Baumgartner W, Reitz B (1988) Surgical management of renal cell carcinoma with intracaval neoplasic extension above the hepatic veins. J Urol 139: 1166–72PubMedGoogle Scholar
  31. 31.
    Marshall F, Powell KC (1982) Lymphadenectomy for renal cell carcinoma: anatomical and therapeutic considerations. J Urol 128: 677–81PubMedGoogle Scholar
  32. 32.
    Blom J, Van Poppel H, Marechal M (1999) Radical nephrectomy with and without lymph node dissection: preliminary results of the EORTC randomized phase III protocol 30881. Eur Urol 36: 570–5PubMedCrossRefGoogle Scholar
  33. 33.
    Fenn N, Gill I (2004) The expanding indications for laparoscopic radical nephrectomy. BJU Int 94: 761–5PubMedCrossRefGoogle Scholar
  34. 34.
    Ficcara V, Novara G, Iafrate M et al. (2007) Proposal for reclassification of the TNM staging system in patients with locally advanced (pT3-4) renal cell carcinoma according to the cancer related outcome. Eur Urol 51: 722–31CrossRefGoogle Scholar
  35. 35.
    Tsui KH, Shvarts O, Smith RB et al. (2000) Prognostic indicators for renal cell carcinoma: a multivariate analysis of 643 patients using the revised 1997 TNM staging criteria. J Urol 163: 1090–5PubMedCrossRefGoogle Scholar
  36. 36.
    Han K-R, Bui Matthew, Pantuck A et al. (2003) TNM T3a renal cell carcinoma: adrenal gland involvement is not the same as renal fat invasion. J Urol 169: 899–904PubMedCrossRefGoogle Scholar
  37. 37.
    Thompson RH, Leibovich BC, Cheville JC et al. (2005) Should direct ipsilateral adrenal invasion from renal cell carcinoma be classified as pT3a? J Urol 173: 918–21PubMedCrossRefGoogle Scholar
  38. 38.
    Thompson RH, Leibovich BC, Cheville JC et al. (2005) Is renal sinus fat invasion the same as perinephric fat invasion for pT3a renal cell carcinoma? J Urol 174: 1218–21PubMedCrossRefGoogle Scholar
  39. 39.
    Murphy AM, Gilbert SM, Katz AE et al. (2005) Re-evaluation of the tumour-node-metastasis staging of locally advanced renal cortical tumours: absolute size (T2) is more significant than renal capsular invasion (T3a). BJU Int 95: 27–30PubMedCrossRefGoogle Scholar
  40. 40.
    Lam JS, Klatte T, Patard JJ et al. (2007) Prognostic relevance of tumour size in T3a renal cell carcinoma: A multicenter experience. Eur Urol 55: 155–62CrossRefGoogle Scholar
  41. 41.
    Palapattu GS, Pantuck AJ, Dorey F et al. (2003) Collecting system invasion in renal cell carcinoma: impact on prognosis and future staging strategies. J Urol 170: 768–72PubMedCrossRefGoogle Scholar
  42. 42.
    C. Terrone, C. Cracco, S. Guercio et al. (2004) Prognostic value of the involvement of the urinary collecting system in renal cell carcinoma. Eur Urol 46: 472–6PubMedCrossRefGoogle Scholar
  43. 43.
    Bissada N, Yakout H, Babanouri A et al. (2003) Long-term experience with management of renal cell carcinoma involving the inferior vena cava. Urology 61: 89–92PubMedCrossRefGoogle Scholar
  44. 44.
    Kim L, Zisman A, Han K et al. (2004) Prognostic significance of venous thrombus in renal cell carcinoma. Are renal vein and inferior vena cava involvement different? J Urol 171: 588–91PubMedCrossRefGoogle Scholar
  45. 45.
    Parekh D, Cookson M, Chapman W et al. (2005) Renal cell carcinoma with renal vein and inferior vena cava involvement: clinicopathological features, surgical techniques and outcome. J Urol 173: 1897–902PubMedCrossRefGoogle Scholar
  46. 46.
    Zini L, Haulon S, Leroy X et al. (2006) Endoluminal occlusion of the inferior vena cava in renal cell carcinoma with retro-or suprahepatic cava thrombus. BJU Int 97: 1216–20PubMedCrossRefGoogle Scholar
  47. 47.
    Zisman A, Wieder JA, Pantuck AJ et al. (2003) Renal cell carcinoma with tumor thrombus extension: biology, role of nephrectomy and response to immunotherapy. J Urol 169: 906–16CrossRefGoogle Scholar
  48. 48.
    Zisman A, Pantuck AJ, Chao DH et al. (2002) Renal cell carcinoma with tumor thrombus: is cytoreductive nephrectomy for advanced disease associated with an increased complication rate? J Urol 168: 962–7PubMedCrossRefGoogle Scholar
  49. 49.
    Gettman M, Boelter C, Cheville J et al. (2003) Charlson co-morbidity index as a predictor of outcome after surgery for renal cell carcinoma with renal vein, vena cava or right atrium extension. J Urol 169: 1282–6PubMedCrossRefGoogle Scholar
  50. 50.
    Moinzadeh A, Libertino J (2004) Prognostic significance of tumor thrombus level in patients with renal cell carcinoma and venous tumor thrombus extension. Is all T3b the same? J Urol 171: 598–601PubMedCrossRefGoogle Scholar
  51. 51.
    Leibovich B, Cheville J, Lohse C et al. (2005) Cancer specific survival for patients with pT3b renal cell carcinoma-can the 2002 primary tumor classification be improved? J Urol 173: 716–9PubMedCrossRefGoogle Scholar
  52. 52.
    Wagner B, Patard J, Méjean A et al. (2007) Prognostic value of renal vein (RV) and inferior vena cava (IVC) involvement in renal cell carcinoma (RCC). Eur Urol suppl 6: 546Google Scholar
  53. 53.
    Staehler G, Brkovic D (2000) The role of radical surgery for renal cell carcinoma with extension into the vena cava. J Urol 163: 1671–5PubMedCrossRefGoogle Scholar
  54. 54.
    Blute M, Leibovitch B, Lohse C et al. (2004) The Majo clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous thrombus. BJU Int 94: 33–41PubMedCrossRefGoogle Scholar
  55. 55.
    Pantuck AJ, Zisman A, Dorey F et al. (2003) Renal cell carcinoma with retroperitoneal lymph nodes: role of lymph node dissection. J Urol 169: 2076–83PubMedCrossRefGoogle Scholar
  56. 56.
    Canfield S, Kamat A, Sanchez-Ortiz R et al. (2006) Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease (clinical TxN1-2M0): the impact of aggressive surgical resection on patient outcome. J Urol 175: 864–9PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France, Paris 2008

Authors and Affiliations

  • Hervé Lang
    • 1
  • Didier Jacqmin
    • 1
  • Catherine Roy
    • 1
  • Frédéric Fernandez
    • 1
  • Bernard Wagner
    • 1
  • Pascal Mouracadé
    • 1
  1. 1.Service ďUrrologieCHU StrasbourgStrasbourg cedexFrance

Personalised recommendations