Organerhaltende Nierenchirurgie 2012

Zusammenfassung

Die organerhaltende Nierentumorchirurgie ist das Standardverfahren zur operativen Therapie kleiner Raumforderungen der Niere. Ihr kommt bei steigender Lebenserwartung der Patienten und zunehmender Inzidenz von Nierenraumforderungen und zudem steigender Verfügbarkeit und besserer Qualität der diagnostischen Mittel eine nicht zu unterschätzende onkologische und auch sozialökonomische Bedeutung zu. In vorliegender Übersichtsarbeit sollen an Hand der aktuellen Literatur die Situation der organerhaltenden Nierenchirurgie vorgestellt, die zur Verfügung stehenden Methoden kritisch betrachtet und ein Ausblick über mögliche Entwicklungen und notwendige weiterführende Untersuchungen gegeben werden. Die Ergebnisse der vorliegenden Studien kommen zusammenfassend zu dem Schluss, dass die organerhaltende Nierenchirurgie gut untersucht ist und die vorgestellten Operationsmethoden sicher anwendbar sind bei vergleichbaren onkologischen Ergebnissen zur radikalen Nephrektomie. Die Vorteile der organerhaltenden Nierentumorchirurgie liegen in den besseren Langzeitergebnissen für das Überleben und die Morbidität der Patienten. Hier ist vor allem die chronische Niereninsuffizienz zu beachten. Zusammenfassend sollte unserer Meinung nach jeder Nierentumor wenn möglich organerhaltend operiert werden.

Abstract

Nephron-sparing surgery is considered to be the standard surgery for small renal masses. There is a large socioeconomic and oncological relevance in such a decision, especially since tumour incidence as well as average life expectancy increases, also triggered by better diagnostic quality. The present review highlights the current state of nephron sparing-surgery, evaluates different surgical approaches and gives perspectives on the future developments and scientific investigations required. In conclusion, nephron-sparing surgery has been well studied and different approaches have shown high safety profiles with oncological results comparable to those of radical nephrectomy. Nephron -sparing surgery provides decisive advantages in long-term survival and patient morbidity, especially concerning chronic renal failure rates. Therefore, whenever feasible, a renal mass should be considered for nephron-sparing surgery.

Schlüsselwörter

organerhaltende ­Nierenchirurgie - minimalinvasiv - Nierenfunktion

Key words

nephron-sparing surgery - minimally invasive surgery - renal function

• Literatur

• 1 Czerny H. Ueber Nierenextirpation. Beitr klin Chir. : 1890. 6. 495
• 2 Ljungberg B, Cowan NC, Hanbury DC et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 2010; 3: 398-406
• 3 Campbell SC, Novick AC, Belldegrun A et al. Guideline for management of the clinical T1 renal mass. J Urol 2009; 182 (04) 1271-1279
• 4 Roos FC, Pahernik S, Brenner W et al. Imperative and elective indications for nephron-sparing surgery for renal tumors: long-term oncological follow-up. Aktuel Urol 2010; (Suppl. 01) S70-S76
• 5 Volpe A, Panzarella T, Rendon RA et al. The natural history of incidentally detected small renal masses. Cancer 2004; 100 (04) 738-745
• 6 Jemal A, Siegel R, Xu J et al. Cancer statistics. 2010; CA Cancer J Clin 60 (05) 277-300
• 7 Mathew A, Devesa SS, Fraumeni Jr JF et al. Global increases in kidney cancer incidence, 1973–1992. Eur J Cancer Prev 2002; 11 (02) 171-178
• 8 Van Poppel H, Becker F, Cadeddu JA et al. Treatment of localised renal cell carcinoma. Eur Urol 2011; [phone]
• 9 Frommhold J, Jocham D, Doehn C. How Accurate is the Correlation between Clinical and Pathological TNM Stages in Renal Tumours?. Aktuelle Urol 2011; 42: 247-251
• 10 Frank I, Blute ML, Cheville JC et al. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol Dec 2003; 170 () 2217-2220
• 11 Rosenkrantz AB, Hindman N, Fitzgerald EF et al. MRI features of renal oncocytoma and chromophobe renal cell carcinoma. AJR Am J Roentgenol 2010; (06) W421-W427
• 12 Tan HJ, Norton EC, Ye Z et al. Long-term survival following partial vs. radical nephrectomy among older patients with early stage kidney cancer. JAMA 2012; 307 (15) 1629-1635
• 13 Go AS, Chertow GM, Fan D et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351 (13) 1296-1305
• 14 Hollingsworth JM, Miller DC, Daignault S et al. Five-year survival after surgical treatment for kidney cancer: a population-based competing risk analysis. Cancer 2007; 109 (09) 1763-1768
• 15 Childs M, Lohse C, Cheveille J. Radica nephrectomy for benign renal masses is associated with diminished overall survival compared with partial nephrectomy. J Urol 2012; 185 (04) Abstr. 1073
• 16 Schrader AJ, Steffens S. Renal Cell Carcinoma Update: News from the AUA, EAU, and ASCO Annual Meetings 2011. ISRN Urol 2012; 748235
• 17 Roos FC, Rübben C, Stief C et al. Surgical Treatment for Renal Cell Carcinoma. Aktuelle Urol 2010; 41: 252-256
• 18 Van Poppel H, Da Pozzo L, Albrecht W et al. A rospective, 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 J Urol 2011; 59: 543-552
• 19 Terrone C, Volpe A. Can Emerging Level 1 Evidence "Discourage" Elective Nephron-Sparing Surgery for Small renal Tumors?. Eur Urol 2011; 59: 553-555
• 20 Ganesamoni R, Mavuduru R, Agarwal MM et al. 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 2011; 59: 543-552 Eur Urol 2011; 60: e9
• 21 Sun M, Hansen J, Karakiewicz PI et al. A Prospective, Randomized 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. 2011. 59. 543-552 Eur Urol 2011; 61: e37–e38
• 22 Chang SL, Cipriano LE, Brunello SM et al. Economic and clinical consequences of new onset post-operative chronic kidney disease following radical and partial nephrectomy in the management of small renal masses. J Urol 2011; 185 (04) e612-e613
• 23 Dulabon LM, Lowrance WT, Russo P et al. Trends in renal tumor surgery delivery within the United States. Cancer 2010; 116 (10) 2316-2321
• 24 Kates M, Badalato GM, Pitman M et al. Increased risk of overall and cardiovascular mortality after radical nephrectomy for renal cell carcinoma 2 cm or less. J Urol Oct 2011; 186 (04) 1247-1253
• 25 Lüdecke G, Geiges G, König J et al. Versorgungsforschung des IQUO liefert Antworten: Wie steht es um die "organerhaltende" Therapie beim Nierenzellkarzinom für die Patienten, die von Urologen des IQOU betreut werden?. Urologe A 2012; 2012 Sppl (P9)
• 26 Becker F, Siemer S, Kamradt J et al. Important aspects of organ-preserving surgery for renal tumors: indications, new standards, and oncological outcomes. Dtsch Arztebl Int Feb 2009; 106 (08) 117-122
• 27 Becker F, Van Poppel H, Hakenberg OW et al. Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol Oct 2009; 56 (04) 625-634
• 28 Thompson RH, Frank I, Lohse CM et al. The Impact of ischemia time during open nephron sparing surgery on solitary kidneys: a multi-institutional study. J Urol 2007; 177: 471-476
• 29 Thompson RH, Lane BR, Lohse CM et al. Comparison of warm ischemia time versus no ischemia during partial nephrectomy on a solitary kidney. Eur Urol 2010; 58: 331-336
• 30 Smaldone MC, Kutikov A, Egleston B et al. Assessing Performance Trends in Laparoscopic Nephrectomy and Nephron-sparing Surgery for Localized Renal Tumors. Urology 2012; 80 (02) 286-292
• 31 Crepel M, Jeldres C, Sun M et al. A population-based comparison of cancer-control rates between radical and partial nephrectomy for T1A renal cell carcinoma. Urology 2010; [phone]
• 32 Lee CT, Katz J, Shi W et al. Surgical management of renal tumors 4 cm or less in a contemporary cohort. J Urol 2000; 163 (03) 730-736
• 33 Roos FC, Brenner W, Muller M et al. Oncologic long-term outcome of elective nephron-sparing surgery versus radical nephrectomy in pa­tients with renal cell carcinoma stage pT1b or greater in a matched-pair cohort. Urology 2011; 77 (04) 803-808
• 34 Turna B, Aron M, Gill IS. Expanding indications for laparoscopic partial nephrectomy. Urology 2008; 72 (03) 481-487
• 35 Gill IS, Colombo Jr JR, Moinzadeh A et al. Laparoscopic partial nephrectomy in solitary kidney. J Urol 2006; 175 (02) 454-458
• 36 Turna B, Frota R, Kamoi K et al. Risk factor analysis of postoperative complications in laparoscopic partial nephrectomy. J Urol 2008; 179 (04) 1289-1294 discussion 94–95
• 37 Simmons MN, Gill IS. Decreased complications of contemporary laparoscopic partial nephrectomy: use of a standardized reporting system. J Urol 2007; 177 (06) 2067-2073 discussion 73
• 38 Aboumarzouk OM, Stein RJ, Eyraud R et al. Robotic Versus Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis. Eur Urol 2012; Epub ahead of print
• 39 Cindolo L, Greco F, Fonara P et al. Nephron sparing LESS: technique and review of the current literature. Arch Esp Urol 2012; 65 (03) 303-310
• 40 Tobis S, Knopf JK, Silvers CR et al. Near infrared fluorescence imaging after intervenous indocyanine green: initial clinical experience with open partial nephrectomy for renal cortical tumors. Urol J 2012; 79 (04) 958-964
• 41 Ng CK, Gill IS, Patil MB et al. Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy. Eur Urol 2012; 61 (01) 67-74
• 42 Patil MB, Lee DJ, Gill IS. Eliminating global renal ischemia during partial nephrectomy: an anatomical approach. Curr Opin Urol 2012; 22 (02) 83-87
• 43 Gill IS, Eisenberg MS, Aron M et al. Zero Ischemia partial nephrectomy: novel lapraoscopic and robotic technique. Eur Urol 2010; 59 (01) 128-134