Elective conservative surgery and renal tumour multifocality: our experience

282

281 MANAGEMENT NEPHRECTOMY

OF

LOCAL

RECURRENCE

Matveev Vsevolod’ , Davidov Michailz, Romanov Vladimir’, Mitin Andrey’

AFTER

RETROPERITONEOSCOPIC RADICAL ONCOLOGICALLY ADEQUATE?

RADICAL

Matveev Boris’, Figurin Konstantin’ .

l&l&

NEPHRECTOMY:

IS

IT

Hou S., Li K.W

‘Urology, Cancer Research Centre, Moscow, Russia. ‘Thoraco-abdominal surgical oncology, Cancer Research Centre, Moscow. Russia

Surgery. Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong

INTRODUCTION & OBJECTIVES: Local recurrence of renal cell carcinoma after nephrectomy indicates a poor prognosis with only 14% of patients surviving one year. We evaluated the outcome of patients with local recurrence treated with aggressive surgery.

INTRODUCTION & OBJECTIVES: The hallmark of radical nephrectomy is the dissection of kidney outside gerota fascia. The need for adrenalectomy and lymphadenectomy remains controversial. Retroperitoneoscopic radical nephrectomy (RRN) for renal cell carcinoma (RCC) had been reported but its oncological adequacy was never confirmed. We reviewed our experience of RRN for RCC to attempt to answer this question.

MATERIALS & METHODS: We retrospectively fossa recurrence considered for surgical treatment 1980 and 1999.

analysed 34 cases of renal at our institution between

RESULTS: Average interval to recurrence was 26.5 months (range 4.5-122) after nephrectomy with 71.64 of patients being symptomatic. The main pre\enting,symptoma were lumber pain, fatigue and fever. Complete resection was possible in 24 (70.5%) patients and required splenectomy (4). hemicolectomy (3), distal pancreatectomy (2), ipsilateral adrenalectomy (I), resection of the small bowel (2). liver (I), diaphragm (I) and marginal IVC resection (3). Simultaneous removal of solitary metastasis from postoperative scar and the lung was performed in 3 and I cases respectively. Average blood loss was I500 cc (range 200 to 8000). Of the 34 patients IO (29.4%) had serious postoperative complications. including pneumonia, small bowel fist&t, peritonitis. acute renal failure. subhepatic abscess, delayed haemorrhage and small bowel obstruction. Of all 34 patients IO are alive a median of 54 months (range l6- lO9), I5 died of disease progression a median of 26 (range I-99) months after the surgery, 4 (I I .7%) died of postoperative complications and 5 were lost for follow-up. Overall 2-, 3.. and 5.year survival of the whole group was 60.4%. 54%, and 37.7% respectively. The patients who had complete resection of all macroscopic disease had better survival compared to the patient\ in whom complete resection was not possible (p
MATERIALS & METHODS: All cases of RCC by RRN were identified. The patient status regarding disease recurrence at the last follow-up was noted. The oncological quality of the nephrectomy specimen was defined by reviewing the pathology report. RESULTS: A total of 30 RRN were attempted for RCC since 1996. Twenty-five were successfully performed and 21 turnours were confirmed to be RCC. Specimen Parameter Staging (TDT2iT3) Lateralitv

No. of Patient 71 I o/4 9112

R/L)

There was no disease recurrence detected clinically and by C.T. abdomen chest X-Ray at a median follow up of 24 months (range 7-49).

CONCLUSION: RRN can fulfil the oncological requirement to include the gerota fascia and achieve a clear surgical margin. Medium term of follow up show good disease control by the retroperitoneoscopic approach.

283 ELECTIVE CONSERVATIVE SURGERY MULTIFOCALITY: OUR EXPERIENCE

AND

RENAL

Mearini Ettore. Mearini Luigi, Costantini Elisabetta. Salomone w.

Porena

TUMOUR

Umberto.

and

284 COMPLICATED NECESSARY?

RENAL

CYSTS

-

IS

OPERATION

ALWAYS

Aleasandro

Fernander

Massimo

Salvador, Friedrich Martin, Heinzer Hans, Huland Hartwig

Urology Department, University of Perugia, Peru~ia, Italy

INTRODUCTION & OBJECTIVES: Nephron sparing surgery (NSS) for renal tumour is indicated when the disease is bilateral and in cases of renal failure or solitary kidney. It may be elective depending on tumour rite and stage. Many studies show survival rates after radical and conservative surgery overlaps when turnour\ are at the same stage. therefore 5 years survival

if turnours

are small,

rate is 8%8X%

the risk associated

with

NSS

MATERIALS & METHODS: patient\.

Who

underwent

of apparently Tissue

healthy

samples

present.

All

The

elective

were

examined were

incidence

NSS

parenchyma

turnours

conservative

and the local relapse

by pathologists

to determine

follow-up

forms.

papillary

udenoma,

suffered

a local

developed

I

surgery

(clear

another

case 3 months

years,

after

recurrence

cell

which

recurrence.

The

CONCLUSION: &e.

of

nephrectomy synchronous parenchyma

they

19%

Multifocal with radical

multifocal

or NSS.

2 papillary

urgical

I

margins of

papillary

follow-up.

infiltration

was

increased

without

rate

wa\

any

I .X%

cases

of I

No

In fact

multifocal

diaeahe

and tumour

a O-38

incidence

surgery

disease. only

disease

developed

the metasmbes lymph

(I

disease

(peritumoural

tissue)

diameter

in

for two

nodes

or renal

with

systemic

patient

is certainly

which and

was

are commonly

of multifocality

the percentage 3 of our

overtreatment.

detected

(5.6%)

histologically

in 2 cases the satellite

there

in most

presented lesions

in

to

<3 ems in

Although

is not so high

patients

believed

in tamours

are

series

of

homolateral the

healthy

were

benign.

Comequently it is impossible to establish the future biological behaviour of this lesions their link? with the primary turnours. NS surgery carries the risk of not fully eradicating the disease hut it conserves

renal function

Hamburg,

Germany

INTRODUCTION & OBJECTIVES: Despite significant advances in diagnostic imaging complicated renal cysts are a diagnostic dilemma. It is still controversially debated if surgery is necessary in all cases to avoid overtreatment. We therefore reviewed operative complications, histopathologic findings in frozen sections and paraffin sections, and the clinical course of patients with complicated renal cysts (Bosniak score 11).

and the residual

MATERIALS & METHODS: Between 1996 and August 2001 open surgery was performed in 2 I cases with complicated renal cysts diagnosed by CT scan. Indication for surgery was defined if the CT scan revealed cyst septation, calcium in cyst wall. multiple septs, internal echo, contrast media enhancement or hyperdense cyst fluid (20 HE).

patients

with conservative

me&stases,

stahilised

S

indicated

contralateral

and wa$ treated

therapy

in size

mortality

3

lesions

adenocarcinoma.

lymphnode

radical

adenocarcinoma. (r. 12-203). detected

satellite

Asynchronous

after surgery

Mediartinum

related

cm

adenocarcinomu).

proportion

In these patients

reports

during

after surgery:

time

m 53

at least 0.5-l

whether

was 54 months

Histology

and

(I .tW)one year

tumour

of

(5.6%‘).

oncocytomn

carcinoma).

of papillary

he in inverse

examinations

recurrence

in one case

Mean

disease

2000):

with mean diameter of 2.6 ems (r.l.2.6cma). cell carcinoma,

multifocal

ih

Hospital Hamburg,

the lesion was taken from each patient.

Histological findings showed 43 clear

synchronous

The

Multifocality

was evaluated

1990.January

surrounding

peripheral

RESULTS: Histological

may be indicated.

of multifocality

(January

oncocytoma

and 3 mixed

surgery

rate about 9-I(%.

(7.19%).

Urology. University

dlaease can be treated

later.

RESULTS: Patients’ age was 12-75 years. 8 patients were operated by flank incision, 13 cases were operated transperitoneal. Nephron sparing surgery could be performed in 20 cases, in one patient nephrectomy had to be performed. Blood loss was 50-1000 ml (medium blood loss 420 ccm). Perioperative complications consisted in a urine extravasation in 2 patients and injury of the pleura in one case. The frozen sections revealed malignancy in 5121 (24%) patients whereas final histopathologic examination on HE sections showed malignancy in 6/2l (29%) cases. 5 of the malignant cases turned out to be renal cell carcinomas, I case was a metastasis of a testicular carcinoma. In addition I case showed a cystic nephrom. CONCLUSION: Complicated renal cysts have a high risk (in our series up to 30%) of malignancy. We therefore recommend that even cysts with a Bosniak score of II-III should consequently be explored. European

Urology

Supplements

1 (2002)

No. 1, pp. 73