Нужна ли технически сложная резекция больным опухолями почечной паренхимы с нормальной контрлатеральной почкой?

Objective: to compare the results of partial (PN) and radical nephrectomy (RN) in patients with renal parenchymal tumors with nephrometric PADUA index ≥8 and/or RENAL index ≥7 and functioning contralateral kidney.Materials and methods. Medical data of 114 consecutive patients with renal cell carcinoma (RCC) cT1–3aN0M0 and functioning contralateral kidney were included into the study: 57 (50.0 %) persons undergone PN for tumors with nephrometric PADUA index ≥8 and/or RENAL index ≥7 (the main group), and 57 (50.0 %) patients undergone RN (the control group). The groups were comparable with regards to demographic characteristics, nephrometric parameters, morphological tumor features, and baseline glomerular filtration rate (р >0.05 for all). Median follow-up – 52.0 ± 23.6 (9.1–138.5) months.Results. Technically complicated PNs were associated with an increase of median surgery time (by 39 min, р = 0.06), blood loss (by 319 ml, p within the groups. Chronic kidney disease (CKD) progression rate was significantly higher in RN than in PN group (40 % vs 31.6 % respectively, р = 0.050), including more frequent development of CKD stages III–IV (31.6 % vs 26.3 % respectively; р = 0.034). There was no difference of long-term survival between PN and RN groups, and that included survival results stratified according to gender, age, baseline CKD stage, PADUA and RENAL indexes. Five-year recurrence-free survival was 94.1 % vs 92.2 % (р = 0.223), cancer-specific survival – 92.3 % vs 90.8 % (р = 0.443), cardio-specific survival – 91.6 % vs 77.9 % (р = 0.549), overall survival – 89.8 % vs 70.7 % respectively (р = 0.858).Conclusion. PN is effective and safe method of treatment in patients with renal parenchymal tumors with PADUA index ≥8 and/or RENAL index ≥7 and functioning contralateral kidney, providing significant functional benefit without survival compromising when compared with RN.Цель исследования -провести сравнительный анализ результатов резекции почки и радикальной нефрэктомии у больных опухолями почечной паренхимы с нефрометрическим индексом PADUA ≥8 и/или RENAL ≥7 баллов и функционирующей контралатеральной почкой.Материал и методы. В исследование ретроспективно и проспективно включены медицинские данные 114 больных раком почки cT1-3aN0M0: 57 (50,0%) пациентов, подвергнутых резекции почки по элективным показаниям, с опухолями почечной паренхимы с нефрометрическим индексом PADUA ≥8 и/или RENAL ≥7 баллов и функционирующей контралатеральной почкой (основная группа) и 57 (50,0%) больных, которым была выполнена  радикальная нефрэктомия (контрольная группа). Группы пациентов были сопоставимы демографическим характеристикам, нефрометрическим и морфологическим признакам опухоли, исходной почечной функции (р>0,05 для всех). Медиана наблюдения - 52,0±23,6 (9,1-138,5) мес.Результаты. Технически сложные резекции почки были ассоциированы с увеличением медианы операционного времени (на 39 мин, р=0,06), объема кровопотери (на 319 мл, p<0,0001) и частоты послеоперационных осложнений (21,1% и 8,8% соответственно, р=0,056) за счет нежелательных явлений 1-2 степеней тяжести по сравнению с радикальной нефрэктомией. Мочевой затек развился у 8,8% больных основной группы; других различий структуры послеоперационных осложнений в группах не отмечено. Частота прогрессирования хронической болезни почек (ХБП) была выше после радикальной нефрэктомии, чем после резекции почки (40% и 31,6% соответственно, р=0,050), в том числе – за счет развития ХБП 3-4 стадий (31,6% и 26,3% соответственно, р=0,034). Значимых различий отдаленной выживаемости между пациентами основной и контрольной групп, в том числе, - при стратификации результатов по полу, возрасту, стадии исходной ХБП, индексам PADUA и RENAL, не выявлено: 5-летняя безрецидивная выживаемость - 94,1% и 92,2% (р=0,223), ракоспецифическая выживаемость - 92,3% и 90,8% (р=0,443),  кардиоспецифическая выживаемость – 91,6% и 77,9% (р=0,549), общая выживаемость – 89,8% и 70,7% соответственно (р=0,858).Заключение. Резекция почки - эффективный и безопасный метод лечения больных опухолями почечной паренхимы с нефрометрическим индексом PADUA ≥8 и/или RENAL ≥7 и нормальной контралатеральной почкой, обеспечивающий преимущество в отношении почечной функции без снижения выживаемости по сравнению с радикальной нефрэктомией

Клинический случай лимфомы семенного пузырька

The article presents a clinical case of seminal vesicle lymphoma in a 73-year-old man who was sent for examination at the N.N. Blokhin National Medical Research Center of Oncology with suspected prostate tumor.В статье представлен клинический случай лимфомы семенного пузырька у мужчины 73 лет, который был направлен на  обследование в НМИЦ онкологии им. Н.Н. Блохина с подозрением на опухоль предстательной железы

Резекция единственной функционирующей почки при опухолях почечной паренхимы

Aim: to evaluate results of partial nephrectomy for patients with a solitary kidney performed at the N.N. Blokhin Cancer Center.Materials and methods: medical data of 131 patients with solitary kidney tumors underwent partial nephrectomy at the Department of Urology of the N.N. Blokhin Russian Cancer Research Center from 1980 to 2015 were collected. Median age was 57 (26–75) years, a maleto-female ratio was 1:1.2. Median RENAL score was 7.0 ± 2.4. In all cases, chronic kidney disease was initially diagnosed (stage III – 30 (22.9 %), stage IV–V – 0 (0 %)). Median follow-up for all patients was 55 (6–386) months.Results. The rate of intraoperative complications was 9.2 % (12/131), the rate of postoperative complications was 26.9 % (35/131) (severity grade II – 23 (17.6 %), III – 10 (7.7 %), IV – 1 (0.8 %), V – 1 (0.8 %)). Acute renal failure was observed in 69 (52.7 %) cases, acute dialysis was necessary in 6 (4.6 %) patients. Progression of chronic kidney disease was observed in 58 (44.6 %) patients, hemodialysis was demanded for 2 (1.5 %) patients. Histological study revealed renal cell carcinoma in 124 (94.6 %) samples, positive surgical margins were in 2 (1.5 %) samples. No local recurrences in the resection area were observed. Overall 5- and 10-year survival for all patients with renal cell carcinoma was 89.6 and 72.0 %, specific survival was 93.5 and 81.3 %, recurrence-free survival was 85.3 and 62.2 % respectively.Conclusion. Partial nephrectomy is an effective method of treatment in of solitary kidney tumors associated with satisfactory functional and oncological outcomeЦель: изучение непосредственных и отдаленных результатов серии резекций единственной функционирующей почки, выполненной в РОНЦ им. Н.Н. Блохина. Материал: отобраны данные 131 пациента с опухолью почечной паренхимы единственной функционирующей почки, подвергнутого резекции в отделении урологии РОНЦ им. Н.Н. Блохина с 1980 по 2015 гг. Медиана возраста - 57,0 (26-75) лет, соотношение мужчин и женщин – 1:1,2. Медиана суммы баллов по нефрометрической шкале RENAL составила 7±2,4. Во всех случаях исходно установлен диагноз хронической болезни почек (ХБП) (ХБП ≥3 стадии - 30 (22,9%), ХБП 4-5 стадий – 0 (0,0%)). Медиана наблюдения за всеми пациентами составила 55 (6-386) месяцев. Результаты: частота интраоперационных осложнений – 9,2% (12/131), послеоперационных осложнений – 26,9% (35/131) (степень тяжести II - 23 (17,6%), III – 10 (7,7%), IV – 1 (0,8%), V – 1 (0,8%)). Острое снижение почечной функции зарегистрировано в 69 (52,7%) случаев и потребовало проведения острого диализа у 6 (4,6%) больных. Прогрессирование ХБП зарегистрировано у 58 (44,6%) больных, программный гемодиализ проводится 2 (1,5%) пациентам. Гистологическое исследование выявило рак почки в 124 (94,6%) образца, клетки опухоли по краю разреза имелись в 2 (1,5%) образцах. Местных рецидивов в зоне резекции не было. Пяти- и десятилетняя общая выживаемость всех больных раком почки составила 89,6% и 72,0%, специфическая – 93,5% и 81,3%, безрецидивная – 85,3% и 62,2% соответственно. Заключение: резекция единственной почки – эффективный метод лечения опухолей почечной паренхимы, обеспечивающий хорошие функциональные и онкологические результаты

Is technically complicated partial nephrectomy justified in renal cell carcinoma patients with normal contralateral kidney?

Objective: to compare the results of partial (PN) and radical nephrectomy (RN) in patients with renal parenchymal tumors with nephrometric PADUA index ≥8 and/or RENAL index ≥7 and functioning contralateral kidney.Materials and methods. Medical data of 114 consecutive patients with renal cell carcinoma (RCC) cT1–3aN0M0 and functioning contralateral kidney were included into the study: 57 (50.0 %) persons undergone PN for tumors with nephrometric PADUA index ≥8 and/or RENAL index ≥7 (the main group), and 57 (50.0 %) patients undergone RN (the control group). The groups were comparable with regards to demographic characteristics, nephrometric parameters, morphological tumor features, and baseline glomerular filtration rate (р >0.05 for all). Median follow-up – 52.0 ± 23.6 (9.1–138.5) months.Results. Technically complicated PNs were associated with an increase of median surgery time (by 39 min, р = 0.06), blood loss (by 319 ml, p within the groups. Chronic kidney disease (CKD) progression rate was significantly higher in RN than in PN group (40 % vs 31.6 % respectively, р = 0.050), including more frequent development of CKD stages III–IV (31.6 % vs 26.3 % respectively; р = 0.034). There was no difference of long-term survival between PN and RN groups, and that included survival results stratified according to gender, age, baseline CKD stage, PADUA and RENAL indexes. Five-year recurrence-free survival was 94.1 % vs 92.2 % (р = 0.223), cancer-specific survival – 92.3 % vs 90.8 % (р = 0.443), cardio-specific survival – 91.6 % vs 77.9 % (р = 0.549), overall survival – 89.8 % vs 70.7 % respectively (р = 0.858).Conclusion. PN is effective and safe method of treatment in patients with renal parenchymal tumors with PADUA index ≥8 and/or RENAL index ≥7 and functioning contralateral kidney, providing significant functional benefit without survival compromising when compared with RN

Clinical case of lymphoma of the seminal vesicle

The article presents a clinical case of seminal vesicle lymphoma in a 73-year-old man who was sent for examination at the N.N. Blokhin National Medical Research Center of Oncology with suspected prostate tumor

Partial nephrectomy for patients with a solitary kidney

Aim: to evaluate results of partial nephrectomy for patients with a solitary kidney performed at the N.N. Blokhin Cancer Center.Materials and methods: medical data of 131 patients with solitary kidney tumors underwent partial nephrectomy at the Department of Urology of the N.N. Blokhin Russian Cancer Research Center from 1980 to 2015 were collected. Median age was 57 (26–75) years, a maleto-female ratio was 1:1.2. Median RENAL score was 7.0 ± 2.4. In all cases, chronic kidney disease was initially diagnosed (stage III – 30 (22.9 %), stage IV–V – 0 (0 %)). Median follow-up for all patients was 55 (6–386) months.Results. The rate of intraoperative complications was 9.2 % (12/131), the rate of postoperative complications was 26.9 % (35/131) (severity grade II – 23 (17.6 %), III – 10 (7.7 %), IV – 1 (0.8 %), V – 1 (0.8 %)). Acute renal failure was observed in 69 (52.7 %) cases, acute dialysis was necessary in 6 (4.6 %) patients. Progression of chronic kidney disease was observed in 58 (44.6 %) patients, hemodialysis was demanded for 2 (1.5 %) patients. Histological study revealed renal cell carcinoma in 124 (94.6 %) samples, positive surgical margins were in 2 (1.5 %) samples. No local recurrences in the resection area were observed. Overall 5- and 10-year survival for all patients with renal cell carcinoma was 89.6 and 72.0 %, specific survival was 93.5 and 81.3 %, recurrence-free survival was 85.3 and 62.2 % respectively.Conclusion. Partial nephrectomy is an effective method of treatment in of solitary kidney tumors associated with satisfactory functional and oncological outcom

Functional results of partial nephrectomy in solitary functioning kidney tumors

Objective: to assess the early and late functional results of partial nephrectomy in patients with solitary functioning kidney tumors.Materials and methods. Medical data of 131 consecutive patients with solitary kidney parenchymal tumor, who had undergone partial nephrectomy at the N. N. Blokhin Russian Cancer Research Center, were analyzed. The median age was 57 (26–75) years. All the patients were diagnosed with solitary kidney tumor (median RENAL score was 7.0 ± 2.4 and median PADUA score was 9.0 ± 2.2). The median baseline glomerular filtration rate (GFR) was 74 (33–159) ml/min/1.73 m2 (30 (22.9 %) – stage III chronic kidney disease (CKD) and 0 (0 %) – stages IV–V CKD). All the patients underwent partial nephrectomy (with ischemia in 98 (74.8 %) patients, including cold ischemia in 59 (45.1 %)). The median time of ischemia was 24 (7–80) min. The median blood loss was 800 (20–4500) ml.Results. Acute renal injury was recorded in 69 (52.7 %) cases; 6 patients (4.6 %) had indications for acute dialysis. The independent risk factors of acute renal injury were sinus invasion (hazard ratio (HR) 0.08; 95 % confidence interval (CI) 0.03–0.22; p = 0.051), baseline GFR <80 ml/min/1.73 m2 (HR 0.45; 95 % CI 0.22–0.92; p = 0.021), parenchymal ischemia (HR 0.13; 95 % CI 0.05–0.33; p = 0.032), and >500-ml blood loss (HR 0.24; 95 % CI 0.12–0.51; p = 0.005). Progression of previously diagnosed CKD was recorded in 58 (44.6 %) patients; chronical dialysis was required in 2 (1.5 %) patients. The independent risk factors of CKD progression were sinus invasion (HR 0.38; 95 % CI 0.18–0.81; p = 0.002), medial location of the tumor (HR 0.19; 95 % CI 0.09–0.41; p = 0.001), baseline GFR, <60 ml/min/1.73 m2 (HR 0.24; 95 % CI 0.10–0.56; p <0.0001), warm ischemia (HR 0.41; 95 % CI 0.17–1.00; p = 0.052).Conclusion. Solitary kidney resection is associated with a low risk for renal function loss. To achieve optimal functional results, it is desirable to follow the balance between the indications for renal vessel ligation and the need to avoid >500-ml blood loss and cold ischemia