8 research outputs found
ΠΡΠΆΠ½Π° Π»ΠΈ ΡΠ΅Ρ Π½ΠΈΡΠ΅ΡΠΊΠΈ ΡΠ»ΠΎΠΆΠ½Π°Ρ ΡΠ΅Π·Π΅ΠΊΡΠΈΡ Π±ΠΎΠ»ΡΠ½ΡΠΌ ΠΎΠΏΡΡ ΠΎΠ»ΡΠΌΠΈ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΠΏΠ°ΡΠ΅Π½Ρ ΠΈΠΌΡ Ρ Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΠΎΠΉ ΠΊΠΎΠ½ΡΡΠ»Π°ΡΠ΅ΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΠΎΡΠΊΠΎΠΉ?
Objective: to compare the results of partial (PN) and radical nephrectomy (RN) in patients with renal parenchymal tumors with nephrometric PADUA index β₯8 and/or RENAL index β₯7 and functioning contralateral kidney.Materials and methods. Medical data of 114 consecutive patients with renal cell carcinoma (RCC) cT1β3aN0M0 and functioning contralateral kidney were included into the study: 57 (50.0 %) persons undergone PN for tumors with nephrometric PADUA index β₯8 and/or RENAL index β₯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 (Ρ >0.05 for all). Median follow-up β 52.0 Β± 23.6 (9.1β138.5) months.Results. Technically complicated PNs were associated with an increase of median surgery time (by 39 min, Ρ = 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, Ρ = 0.050), including more frequent development of CKD stages IIIβIV (31.6 % vs 26.3 % respectively; Ρ = 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 % (Ρ = 0.223), cancer-specific survival β 92.3 % vs 90.8 % (Ρ = 0.443), cardio-specific survival β 91.6 % vs 77.9 % (Ρ = 0.549), overall survival β 89.8 % vs 70.7 % respectively (Ρ = 0.858).Conclusion. PN is effective and safe method of treatment in patients with renal parenchymal tumors with PADUA index β₯8 and/or RENAL index β₯7 and functioning contralateral kidney, providing significant functional benefit without survival compromising when compared with RN.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ -ΠΏΡΠΎΠ²Π΅ΡΡΠΈ ΡΡΠ°Π²Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ ΠΏΠΎΡΠΊΠΈ ΠΈ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»ΡΠΌΠΈ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΠΏΠ°ΡΠ΅Π½Ρ
ΠΈΠΌΡ Ρ Π½Π΅ΡΡΠΎΠΌΠ΅ΡΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΈΠ½Π΄Π΅ΠΊΡΠΎΠΌ PADUA β₯8 ΠΈ/ΠΈΠ»ΠΈ RENAL β₯7 Π±Π°Π»Π»ΠΎΠ² ΠΈ ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΡΡΡΠ΅ΠΉ ΠΊΠΎΠ½ΡΡΠ°Π»Π°ΡΠ΅ΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΠΎΡΠΊΠΎΠΉ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΒ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΠΈ ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΠ΅ Π΄Π°Π½Π½ΡΠ΅ 114 Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΠ°ΠΊΠΎΠΌ ΠΏΠΎΡΠΊΠΈ cT1-3aN0M0: 57 (50,0%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΏΠΎΠ΄Π²Π΅ΡΠ³Π½ΡΡΡΡ
ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ ΠΏΠΎΡΠΊΠΈ ΠΏΠΎ ΡΠ»Π΅ΠΊΡΠΈΠ²Π½ΡΠΌ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΡΠΌ, Ρ ΠΎΠΏΡΡ
ΠΎΠ»ΡΠΌΠΈ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΠΏΠ°ΡΠ΅Π½Ρ
ΠΈΠΌΡ Ρ Π½Π΅ΡΡΠΎΠΌΠ΅ΡΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΈΠ½Π΄Π΅ΠΊΡΠΎΠΌ PADUA β₯8 ΠΈ/ΠΈΠ»ΠΈ RENAL β₯7 Π±Π°Π»Π»ΠΎΠ² ΠΈ ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΡΡΡΠ΅ΠΉ ΠΊΠΎΠ½ΡΡΠ°Π»Π°ΡΠ΅ΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΠΎΡΠΊΠΎΠΉ (ΠΎΡΠ½ΠΎΠ²Π½Π°Ρ Π³ΡΡΠΏΠΏΠ°) ΠΈ 57 (50,0%) Π±ΠΎΠ»ΡΠ½ΡΡ
, ΠΊΠΎΡΠΎΡΡΠΌ Π±ΡΠ»Π° Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π°Β ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½Π°Ρ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΡ (ΠΊΠΎΠ½ΡΡΠΎΠ»ΡΠ½Π°Ρ Π³ΡΡΠΏΠΏΠ°). ΠΡΡΠΏΠΏΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π±ΡΠ»ΠΈ ΡΠΎΠΏΠΎΡΡΠ°Π²ΠΈΠΌΡ Π΄Π΅ΠΌΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠ°ΠΌ, Π½Π΅ΡΡΠΎΠΌΠ΅ΡΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΈ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΏΡΠΈΠ·Π½Π°ΠΊΠ°ΠΌ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ, ΠΈΡΡ
ΠΎΠ΄Π½ΠΎΠΉ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΈ (Ρ>0,05 Π΄Π»Ρ Π²ΡΠ΅Ρ
). ΠΠ΅Π΄ΠΈΠ°Π½Π° Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ - 52,0Β±23,6 (9,1-138,5) ΠΌΠ΅Ρ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π’Π΅Ρ
Π½ΠΈΡΠ΅ΡΠΊΠΈ ΡΠ»ΠΎΠΆΠ½ΡΠ΅ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ ΠΏΠΎΡΠΊΠΈ Π±ΡΠ»ΠΈ Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π½Ρ Ρ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΌΠ΅Π΄ΠΈΠ°Π½Ρ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ (Π½Π° 39 ΠΌΠΈΠ½, Ρ=0,06), ΠΎΠ±ΡΠ΅ΠΌΠ° ΠΊΡΠΎΠ²ΠΎΠΏΠΎΡΠ΅ΡΠΈ (Π½Π° 319 ΠΌΠ», p<0,0001) ΠΈ ΡΠ°ΡΡΠΎΡΡ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ (21,1% ΠΈ 8,8% ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ, Ρ=0,056) Π·Π° ΡΡΠ΅Ρ Π½Π΅ΠΆΠ΅Π»Π°ΡΠ΅Π»ΡΠ½ΡΡ
ΡΠ²Π»Π΅Π½ΠΈΠΉ 1-2 ΡΡΠ΅ΠΏΠ΅Π½Π΅ΠΉ ΡΡΠΆΠ΅ΡΡΠΈ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΠ΅ΠΉ. ΠΠΎΡΠ΅Π²ΠΎΠΉ Π·Π°ΡΠ΅ΠΊ ΡΠ°Π·Π²ΠΈΠ»ΡΡ Ρ 8,8% Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΉ Π³ΡΡΠΏΠΏΡ; Π΄ΡΡΠ³ΠΈΡ
ΡΠ°Π·Π»ΠΈΡΠΈΠΉ ΡΡΡΡΠΊΡΡΡΡ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Π² Π³ΡΡΠΏΠΏΠ°Ρ
Π½Π΅ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ. Π§Π°ΡΡΠΎΡΠ° ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΠΏΠΎΡΠ΅ΠΊ (Π₯ΠΠ) Π±ΡΠ»Π° Π²ΡΡΠ΅ ΠΏΠΎΡΠ»Π΅ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΠΈ, ΡΠ΅ΠΌ ΠΏΠΎΡΠ»Π΅ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ ΠΏΠΎΡΠΊΠΈ (40% ΠΈ 31,6% ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ, Ρ=0,050), Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ β Π·Π° ΡΡΠ΅Ρ ΡΠ°Π·Π²ΠΈΡΠΈΡ Π₯ΠΠ 3-4 ΡΡΠ°Π΄ΠΈΠΉ (31,6% ΠΈ 26,3% ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ, Ρ=0,034). ΠΠ½Π°ΡΠΈΠΌΡΡ
ΡΠ°Π·Π»ΠΈΡΠΈΠΉ ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΠΎΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ ΠΌΠ΅ΠΆΠ΄Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌΠΈ ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΉ ΠΈ ΠΊΠΎΠ½ΡΡΠΎΠ»ΡΠ½ΠΎΠΉ Π³ΡΡΠΏΠΏ, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅, - ΠΏΡΠΈ ΡΡΡΠ°ΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΠΏΠΎ ΠΏΠΎΠ»Ρ, Π²ΠΎΠ·ΡΠ°ΡΡΡ, ΡΡΠ°Π΄ΠΈΠΈ ΠΈΡΡ
ΠΎΠ΄Π½ΠΎΠΉ Π₯ΠΠ, ΠΈΠ½Π΄Π΅ΠΊΡΠ°ΠΌ PADUA ΠΈ RENAL, Π½Π΅ Π²ΡΡΠ²Π»Π΅Π½ΠΎ: 5-Π»Π΅ΡΠ½ΡΡ Π±Π΅Π·ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½Π°Ρ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ - 94,1% ΠΈ 92,2% (Ρ=0,223), ΡΠ°ΠΊΠΎΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠ°Ρ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ - 92,3% ΠΈ 90,8% (Ρ=0,443),Β ΠΊΠ°ΡΠ΄ΠΈΠΎΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠ°Ρ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ β 91,6% ΠΈ 77,9% (Ρ=0,549), ΠΎΠ±ΡΠ°Ρ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ β 89,8% ΠΈ 70,7% ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ (Ρ=0,858).ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅.Β Π Π΅Π·Π΅ΠΊΡΠΈΡ ΠΏΠΎΡΠΊΠΈ - ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΉ ΠΈ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΡΠΉ ΠΌΠ΅ΡΠΎΠ΄ Π»Π΅ΡΠ΅Π½ΠΈΡ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»ΡΠΌΠΈ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΠΏΠ°ΡΠ΅Π½Ρ
ΠΈΠΌΡ Ρ Π½Π΅ΡΡΠΎΠΌΠ΅ΡΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΈΠ½Π΄Π΅ΠΊΡΠΎΠΌ PADUA β₯8 ΠΈ/ΠΈΠ»ΠΈ RENAL β₯7 ΠΈ Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΠΎΠΉ ΠΊΠΎΠ½ΡΡΠ°Π»Π°ΡΠ΅ΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΠΎΡΠΊΠΎΠΉ, ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠΈΠ²Π°ΡΡΠΈΠΉ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²ΠΎ Π² ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠΈ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΈ Π±Π΅Π· ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΠ΅ΠΉ
ΠΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ Π»ΠΈΠΌΡΠΎΠΌΡ ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡΠΊΠ°
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.Π ΡΡΠ°ΡΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ Π»ΠΈΠΌΡΠΎΠΌΡ ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡΠΊΠ° Ρ ΠΌΡΠΆΡΠΈΠ½Ρ 73 Π»Π΅Ρ, ΠΊΠΎΡΠΎΡΡΠΉ Π±ΡΠ» Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½ Π½Π°Β ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π² ΠΠΠΠ¦ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΈΠΌ. Π.Π. ΠΠ»ΠΎΡ
ΠΈΠ½Π° Ρ ΠΏΠΎΠ΄ΠΎΠ·ΡΠ΅Π½ΠΈΠ΅ΠΌ Π½Π° ΠΎΠΏΡΡ
ΠΎΠ»Ρ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ
Π Π΅Π·Π΅ΠΊΡΠΈΡ Π΅Π΄ΠΈΠ½ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΡΡΡΠ΅ΠΉ ΠΏΠΎΡΠΊΠΈ ΠΏΡΠΈ ΠΎΠΏΡΡ ΠΎΠ»ΡΡ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΠΏΠ°ΡΠ΅Π½Ρ ΠΈΠΌΡ
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 (26β75) years, a maleto-female ratio was 1:1.2. Median RENAL score was 7.0 Β± 2.4. In all cases, chronic kidney disease was initially diagnosed (stage III β 30 (22.9 %), stage IVβV β 0 (0 %)). Median follow-up for all patients was 55 (6β386) 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 β 23 (17.6 %), III β 10 (7.7 %), IV β 1 (0.8 %), V β 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 outcomeΠ¦Π΅Π»Ρ: ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ Π½Π΅ΠΏΠΎΡΡΠ΅Π΄ΡΡΠ²Π΅Π½Π½ΡΡ
ΠΈ ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΡΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΡΠ΅ΡΠΈΠΈ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΉ Π΅Π΄ΠΈΠ½ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΡΡΡΠ΅ΠΉ ΠΏΠΎΡΠΊΠΈ, Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π½ΠΎΠΉ Π² Π ΠΠΠ¦ ΠΈΠΌ. Π.Π. ΠΠ»ΠΎΡ
ΠΈΠ½Π°. ΠΠ°ΡΠ΅ΡΠΈΠ°Π»: ΠΎΡΠΎΠ±ΡΠ°Π½Ρ Π΄Π°Π½Π½ΡΠ΅ 131 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Ρ ΠΎΠΏΡΡ
ΠΎΠ»ΡΡ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΠΏΠ°ΡΠ΅Π½Ρ
ΠΈΠΌΡ Π΅Π΄ΠΈΠ½ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΡΡΡΠ΅ΠΉ ΠΏΠΎΡΠΊΠΈ, ΠΏΠΎΠ΄Π²Π΅ΡΠ³Π½ΡΡΠΎΠ³ΠΎ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ Π² ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠΈ ΡΡΠΎΠ»ΠΎΠ³ΠΈΠΈ Π ΠΠΠ¦ ΠΈΠΌ. Π.Π. ΠΠ»ΠΎΡ
ΠΈΠ½Π° Ρ 1980 ΠΏΠΎ 2015 Π³Π³. ΠΠ΅Π΄ΠΈΠ°Π½Π° Π²ΠΎΠ·ΡΠ°ΡΡΠ° - 57,0 (26-75) Π»Π΅Ρ, ΡΠΎΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΠΌΡΠΆΡΠΈΠ½ ΠΈ ΠΆΠ΅Π½ΡΠΈΠ½ β 1:1,2. ΠΠ΅Π΄ΠΈΠ°Π½Π° ΡΡΠΌΠΌΡ Π±Π°Π»Π»ΠΎΠ² ΠΏΠΎ Π½Π΅ΡΡΠΎΠΌΠ΅ΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠΊΠ°Π»Π΅ RENAL ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 7Β±2,4. ΠΠΎ Π²ΡΠ΅Ρ
ΡΠ»ΡΡΠ°ΡΡ
ΠΈΡΡ
ΠΎΠ΄Π½ΠΎ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ Π΄ΠΈΠ°Π³Π½ΠΎΠ· Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΠΏΠΎΡΠ΅ΠΊ (Π₯ΠΠ) (Π₯ΠΠ β₯3 ΡΡΠ°Π΄ΠΈΠΈ - 30 (22,9%), Π₯ΠΠ 4-5 ΡΡΠ°Π΄ΠΈΠΉ β 0 (0,0%)). ΠΠ΅Π΄ΠΈΠ°Π½Π° Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ Π·Π° Π²ΡΠ΅ΠΌΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 55 (6-386) ΠΌΠ΅ΡΡΡΠ΅Π². Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ: ΡΠ°ΡΡΠΎΡΠ° ΠΈΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ β 9,2% (12/131), ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ β 26,9% (35/131) (ΡΡΠ΅ΠΏΠ΅Π½Ρ ΡΡΠΆΠ΅ΡΡΠΈ II - 23 (17,6%), III β 10 (7,7%), IV β 1 (0,8%), V β 1 (0,8%)). ΠΡΡΡΠΎΠ΅ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΈ Π·Π°ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π½ΠΎ Π² 69 (52,7%) ΡΠ»ΡΡΠ°Π΅Π² ΠΈ ΠΏΠΎΡΡΠ΅Π±ΠΎΠ²Π°Π»ΠΎ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΎΡΡΡΠΎΠ³ΠΎ Π΄ΠΈΠ°Π»ΠΈΠ·Π° Ρ 6 (4,6%) Π±ΠΎΠ»ΡΠ½ΡΡ
. ΠΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ Π₯ΠΠ Π·Π°ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π½ΠΎ Ρ 58 (44,6%) Π±ΠΎΠ»ΡΠ½ΡΡ
, ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ½ΡΠΉ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ°Π»ΠΈΠ· ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΡΡΡ 2 (1,5%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ. ΠΠΈΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΡΡΠ²ΠΈΠ»ΠΎ ΡΠ°ΠΊ ΠΏΠΎΡΠΊΠΈ Π² 124 (94,6%) ΠΎΠ±ΡΠ°Π·ΡΠ°, ΠΊΠ»Π΅ΡΠΊΠΈ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ ΠΏΠΎ ΠΊΡΠ°Ρ ΡΠ°Π·ΡΠ΅Π·Π° ΠΈΠΌΠ΅Π»ΠΈΡΡ Π² 2 (1,5%) ΠΎΠ±ΡΠ°Π·ΡΠ°Ρ
. ΠΠ΅ΡΡΠ½ΡΡ
ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΎΠ² Π² Π·ΠΎΠ½Π΅ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ Π½Π΅ Π±ΡΠ»ΠΎ. ΠΡΡΠΈ- ΠΈ Π΄Π΅ΡΡΡΠΈΠ»Π΅ΡΠ½ΡΡ ΠΎΠ±ΡΠ°Ρ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ Π²ΡΠ΅Ρ
Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΠ°ΠΊΠΎΠΌ ΠΏΠΎΡΠΊΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 89,6% ΠΈ 72,0%, ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠ°Ρ β 93,5% ΠΈ 81,3%, Π±Π΅Π·ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½Π°Ρ β 85,3% ΠΈ 62,2% ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅: ΡΠ΅Π·Π΅ΠΊΡΠΈΡ Π΅Π΄ΠΈΠ½ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΏΠΎΡΠΊΠΈ β ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΉ ΠΌΠ΅ΡΠΎΠ΄ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΠΏΠ°ΡΠ΅Π½Ρ
ΠΈΠΌΡ, ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠΈΠ²Π°ΡΡΠΈΠΉ Ρ
ΠΎΡΠΎΡΠΈΠ΅ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠ΅ ΠΈ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ
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 β₯8 and/or RENAL index β₯7 and functioning contralateral kidney.Materials and methods. Medical data of 114 consecutive patients with renal cell carcinoma (RCC) cT1β3aN0M0 and functioning contralateral kidney were included into the study: 57 (50.0 %) persons undergone PN for tumors with nephrometric PADUA index β₯8 and/or RENAL index β₯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 (Ρ >0.05 for all). Median follow-up β 52.0 Β± 23.6 (9.1β138.5) months.Results. Technically complicated PNs were associated with an increase of median surgery time (by 39 min, Ρ = 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, Ρ = 0.050), including more frequent development of CKD stages IIIβIV (31.6 % vs 26.3 % respectively; Ρ = 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 % (Ρ = 0.223), cancer-specific survival β 92.3 % vs 90.8 % (Ρ = 0.443), cardio-specific survival β 91.6 % vs 77.9 % (Ρ = 0.549), overall survival β 89.8 % vs 70.7 % respectively (Ρ = 0.858).Conclusion. PN is effective and safe method of treatment in patients with renal parenchymal tumors with PADUA index β₯8 and/or RENAL index β₯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 (26β75) years, a maleto-female ratio was 1:1.2. Median RENAL score was 7.0 Β± 2.4. In all cases, chronic kidney disease was initially diagnosed (stage III β 30 (22.9 %), stage IVβV β 0 (0 %)). Median follow-up for all patients was 55 (6β386) 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 β 23 (17.6 %), III β 10 (7.7 %), IV β 1 (0.8 %), V β 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 nephrectomyΒ at the N. N. Blokhin Russian Cancer Research Center, were analyzed. The median age was 57 (26β75) years. All the patients wereΒ diagnosed with solitary kidney tumor (median RENAL score was 7.0 Β± 2.4 and median PADUA score was 9.0 Β± 2.2). The median baselineΒ glomerular filtration rate (GFR) was 74 (33β159) ml/min/1.73 m2 (30 (22.9 %) β stage III chronic kidney disease (CKD) and 0 (0 %) βΒ stages IVβV CKD). All the patients underwent partial nephrectomy (with ischemia in 98 (74.8 %) patients, including cold ischemia in 59Β (45.1 %)). The median time of ischemia was 24 (7β80) min. The median blood loss was 800 (20β4500) ml.Results.Β Acute renal injury was recorded in 69 (52.7 %) cases; 6 patients (4.6 %) had indications for acute dialysis. The independent riskΒ factors of acute renal injury were sinus invasion (hazard ratio (HR) 0.08; 95 % confidence interval (CI) 0.03β0.22; p = 0.051), baselineΒ GFR <80 ml/min/1.73 m2 (HR 0.45; 95 % CI 0.22β0.92; p = 0.021), parenchymal ischemia (HR 0.13; 95 % CI 0.05β0.33; p = 0.032),Β and >500-ml blood loss (HR 0.24; 95 % CI 0.12β0.51; p = 0.005). Progression of previously diagnosed CKD was recorded in 58 (44.6 %)Β patients; chronical dialysis was required in 2 (1.5 %) patients. The independent risk factors of CKD progression were sinus invasion (HR 0.38;Β 95 % CI 0.18β0.81; p = 0.002), medial location of the tumor (HR 0.19; 95 % CI 0.09β0.41; p = 0.001), baseline GFR, <60 ml/min/1.73 m2Β (HR 0.24; 95 % CI 0.10β0.56; p <0.0001), warm ischemia (HR 0.41; 95 % CI 0.17β1.00; p = 0.052).Conclusion. Solitary kidney resection is associated with a low risk for renal function loss. To achieve optimal functional results, it is desirableΒ to follow the balance between the indications for renal vessel ligation and the need to avoid >500-ml blood loss and cold ischemia