Lokalize Böbrek Tümörlerinde Nefron Koruyucu Cerrahi

Günümüzde görüntüleme yöntemlerinin artması ve rutin olarak kullanılması nedeniyle insidental olarak tespit edilen asemptomatik, küçük hacimli lokalize böbrek tümörlerinin sayısında belirgin artış saptanmıştır. Tümörün böbreğe sınırlı kaldığı ve vücuda yayılmadığı kitleler lokalize böbrek kanseri olarak tanımlanmaktadır. Uzun yıllar açık radikal nefrektomi lokalize böbrek tümörlerinin tedavisinde altın standart yöntem olarak kabul edilip uygulanmakla birlikte son 3 dekkaddır organ koruyucu yaklaşım popülarite kazanmıştır. Lokalize böbrek kanserinin yönetiminde laparoskopi ve minimal invaziv tekniklerin getirilmesi ile karşılaştırılabilir onkolojik sonuçlar elde edildi ve morbiditenin azaltılmasına sebep olundu. Lokalize böbrek kanserli hasta için tedavi seçiminin bireyselleştirilmesi gerekir ve onkolojik sonucu etkilemeden böbrek fonksiyonunun korunması karar verme sürecinde en önemli amaç olmalıdır. Hastanın performans durumu ve cerrahi uzmanlığı, hastaya en uygun tedavi seçeneği hakkında tavsiyede bulunurken önemli faktörler olacaktır. Biz bu derlemede lokalize böbrek tümörlerinde nefron koruyucu cerrahinin (NKC) ameliyat yöntemlerini endikasyonları, avantajları ve dezavantajlarını ele aldık.

Anahtar Kelimeler:

Böbrek, Nefron Koruyucu Cerrahi, Böbrek tümörü, Parsiyel Nefrektomi

Nephron-sparing Surgery in Localized Kidney Tumors

As a result of the increasing and routine use of imaging methods, there is a significant increase in the number of asymptomatic small volume localized kidney tumors incidentally detected. The masses which is limited to the kidney and not spread to the body are defined as localized kidney cancer. Although open radical nephrectomy has been accepted as the gold standard method for the treatment of localized renal tumors for many years, organ conservative approach has gained popularity in the last 3 decades. For the patient with localized kidney cancer, the choice of treatment needs to be individualized and the preservation of renal function without affecting the oncologic outcome should be the most important goal in the decision-making process. The patient's performance status and surgical expertise will be important factors in advising the patient about the most appropriate treatment option. In this review, we discussed the indications, advantages and disadvantages of nephron sparing surgery (NSS) in localized renal tumors.

Keywords:

Kidney, Nephron Sparing Surgery, Renal Tumor, Partial Nephrectomy,

PDF

___

Referans1- Parkin DM, Whelan SL, Ferlay J, Raymond L, Young J, (ed.), Cancer incidence in five in continents. v. 7. Lyon: International Agency for Research on Cancer 1997.
Referans2- Chow WH, Devesa SS, Warren JL, Fraumeni JF. Rising incidence of renal cell cancer in the United States. JAMA 1999; 281:1628-1631.
Referans3- McLaughlin JK, Lipworth L, Tarone RE. Epidemiologic aspects of renal cell carcinoma. Semin Oncol. 2006 Oct;33(5):527-33.
Referans4- Stephenson AJ, Chetner MP, Rourke K, Gleave ME, Signaevsky M, Palmer B, Kuan J, Brock GB, Tanguay S. Guidelines for the surveillance of localized renal cell carcinoma based on the patterns of relapse after nephrectomy. J Urol. 2004 Jul;172(1):58-62
Referans5- Novick AC. Renal-sparing surgery for renal cell carcinoma. Urol Clin North Am 1993;20(2):277–282
Referans6- Campbell SC, Novick AC, Belldegrun A, et al; Practice Guidelines Committee of the American Urological Association. Guideline for management of the clinical T1 renal mass. J Urol 2009;182(4): 1271–1279
Referans7- Ljungberg B, Cowan NC, Hanbury DC, et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 2010;58:398–406.
Referans8- Thompson RH, Boorjian SA, Lohse CM, et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol 2008;179: 468–73.
Referans9- Huang WC, Levey AS, Serio AM, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospec- tive cohort study. Lancet Oncol 2006;7:735–40.
Referans10- Margreiter M, Marberger M. Current status of open partial nephrec- tomy. Curr Opin Urol 2010;20:361–4.
Referans11- Marszalek M, Meixl H, Polajnar M, Rauchenwald M, Jescke K, Madersbacher S. Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol 2009;55:1171–8.
Referans12- Klatte T, et al. A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy. Eur Urol. 2015; 68:980–992. DOI: 10.1016/j.eururo.2015.04.010 [PubMed: 25911061]
Referans13- Crestani A, et al. Introduction to small renal tumours and prognostic indicators. Int J Surg. 2016
Referans14- Gill IS, Kavoussi LR, Lane BR, et al. Comparison of 1800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 2007; 178:41–6.
Referans15- Gill IS, Matin SF, Desai MM, et al. Comparative analysis of laparo- scopic versus open partial nephrectomy in 200 cases. J Urol 2003; 170:64–8.
Referans16- Turna B, Frota R, Kamoi K, et al. Risk factor analysis of postopera- tive complications in laparoscopic partial nephrectomy. J Urol 2008;179:1289–95.
Referans17- Simmons MN, Gill IS. Decreased complications of contemporary laparoscopic partial nephrectomy: use of a standardized reporting system. J Urol 2007;177:2067–73.
Referans18- Turna B, Aron M, Gill IS. Expanding indications for laparoscopic partial nephrectomy. Urology 2008;72:481–7.
Referans19- Nadu A, Kleinmann N, Laufer M, Dotan Z, Winkler H, Ramon J. Laparoscopic partial nephrectomy for central tumors: analysis of perioperative outcomes and complications. J Urol 2009;181:42–7.
Referans20- Lane BR, Gill IS. 5-Year outcomes of laparoscopic partial nephrec- tomy. J Urol 2007;177:70–4.
Referans21- Gill IS, Colombo Jr JR, Moinzadeh A, et al. Laparoscopic partial nephrectomy in solitary kidney. J Urol 2006;175:454–8.
Referans22- Permpongkosol S, Bagga HS, Romero FR, Sroka M, Jarrett TW, Kavoussi LR. Laparoscopic versus open partial nephrectomy for the treatment of pathological T1N0M0 renal cell carcinoma: a 5-year survival rate. J Urol 2006;176:1984–9.
Referans23- Thompson RH, Lane BR, Leibovich BC, et al. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol 2010;58:340–5.
Referans24- Lane BR, Gill IS, Fergany AF, Larson BT, Campbell SC. Limited warm ischemia during elective partial nephrectomy has only a marginal impact on renal functional outcomes. J Urol 2011;185: 1598–603.
Referans25- Sampaio FJ.Anatomical background for nephron-sparing surgery in renal cell carcinoma. J Urol. 1992 Apr;147(4):999-1005.
Referans26- Frank I, Colombo JR Jr, Rubinstein M, Desai M, Kaouk J, Gill IS. Laparoscopic partial nephrectomy for centrally located renal tumors. J Urol. 2006 Mar;175(3 Pt 1):849-52.
Referans27- Uzzo RG, Novick AC: Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol. 2001 Jul;166(1):6-18.
Referans28- Novick AC: Nephron-sparing surgery for renal cell carcinoma. Annu Rev Med. 2002; 53: 393-407.
Referans29- Rogers C, Sukumar A, Gill IS. Robotic partial nephrectomy: the real benefit. Curr Opin Urol 2011;21:60–4.
Referans30- Ghani KR, Sukumar S, Sammon JD, Rogers CG, Trinh QD, Menon M. Practice patterns and outcomes of open and minimally invasive partial nephrectomy since the introduction of robotic partial nephrectomy: results from the Nationwide inpatient sample. J Urol 2014;191:907–12.
Referans31- Benway BM, Bhayani SB, Rogers CG, et al. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol 2009;182:866–73.
Referans32- Aboumarzouk OM, Stein RJ, Eyraud R, Haber GP, Chlosta PL, Somani BK, et al. Robotic versus laparoscopic partial nephrec- tomy: a systematic review and meta-analysis. Eur Urol 2012;62:1023–33.
Referans33- Eyraud R, Long JA, Snow-Lisy D, Autorino R, Hillyer S, Klink J, et al. Robot-assisted partial nephrectomy for hilar tumors: perioperative outcomes. Urology 2013;81:1246–52.
Referans34- Shuch B, Singer EA, Bratslavsky G. The surgical approach to multifocal renal cancers: hereditary syndromes, ipsilateral mul- tifocality, and bilateral tumors. Urol Clin North Am 2012;39:133–48.