Number №3, 2019 - page 60-71

Results of kidney resection in patients with renal cell cancer with a high nephrometric index DOI: 10.29188/2222-8543-2019-11-3-60-71

Volkova M.I., Ridin V.A., Chernyaev V.A., Klimov A.V., Figurin K.M., Matveev V.B.
Information about authors:
  • Volkova M.I.- Dr. Med. Sc., leading researcher of Urological Department of the Research Institute of Clinical Oncology named aer Academician of RAS and RAMS N.N. Trapeznikov of Federal State Budgetary Institution «National Medical Research Center for Oncology named after N. N. Blokhin» of
  • Ministry of Health of Russian Federation, mivolkova6@gmail.com; ORCID 0000-0001-7754-6624
  • Ridin Vladimir A. – graduate student of the urological department of the Clinical Oncology Research Institute named aer Academician of RAS and RAMS N.N. Trapeznikov of Federal State Budgetary Institution «National Medical Research Center for Oncology named after N. N. Blokhin» of Ministry of Health of Russian Federation; vovish@mail.ru; ORCID 0000-0002-3588-9191
  • Chernyaev V.A. – PhD, senior researcher Urological Department of the Research Institute of Clinical Oncology named after Academician of RAS and RAMS N.N. Trapeznikov of Federal State Budgetary Institution «National Medical Research Center for Oncology named after N. N. Blokhin» of Ministry of Health of Russian Federation; chercrc@gmail.com; ORCID: 0000-0003-1258-0922
  • Klimov A.V.- Ph.D, researcher of Urological Department of the Research Institute of Clinical Oncology named aer Academician of RAS and RAMS N.N. of Federal State Budgetary Institution «National Medical Research Center for Oncology named after N. N. Blokhin» of Ministry of Health of Russian Federation; klimov_a@bk.ru; ORCID 0000-0001-6287-2937
  • Figurin K.M. – Dr. Med. Sc., professor, senior researcher of Urological Department of the Research Institute of Clinical Oncology named aer Academician of RAS and RAMS N.N. Trapeznikov of Federal State Budgetary Institution «National Medical Research Center for Oncology named after N. N. Blokhin» of Ministry of Health of Russian Federation, kfigurin@mail.ru; ORCID 0000-0001-9158-837X
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Purpose: evaluation of the direct, functional and oncological results of kidney resections in patients with renal parenchyma tumors with a PADUA index of ≥8 and / or RENAL ≥7.

Material and methods: The study included 122 patients who underwent partial nephrectomie for Renal cell cancer with a nephrometric index of PADUA ≥8 and / or RENAL ≥7 (according to obligate indications 65 (53.3%)). The median age is 57 (23-80) years, the ratio of men and women is 1.3: 1. All patients were diagnosed with tumors of the renal parenchyma (bilateral 43 (36.9%)). The median of the Charlson index is 5.0 (2-11). Before surgery, kidney disease (KD) of 3-4 stages was detected in 22 (18.0%)) patients. All patients underwent partial nephrectomie (with clamping of the renal vessels 120 (98.4%), median time of ischemia 23.0 (6-78) min). In 113 (92.6%) patients, one was removed, in 9 (7.4%) more than one tumor node. All patients with bilateral renal cancer from the contralateral side underwent radical nephrectomy. Median follow-up 55.0 ± 29.8 (4-142) months.

Results: the median of the operating time is 150 (60-320) min, the median of the blood loss volume is 600 (10-4500) ml. Intraoperative complications developed in 6 (4.9%), postoperative complications in 32 (26.2%) patients (3-4 degrees of severity 7 (5.7%)). An acute decrease in renal function in the early postoperative period developed in 82 (67.2%), CKD progression in the late postoperative period in 88 (72.1%) patients (new cases of CKD of stages 3-5 in 54 (44.3%) )). Independent risk factors for the development of CKD stages 3-5 were: Charlson index ≥6 (RR = 2.1 (95% CI: 1.2-3.4); p = 0.007) and acute decrease in renal function (RR = 6.0 (95% CI: 1.3-27.2; p = 0.021). The tumor had the structure of renal cell carcinoma (RCC) in 121 (99.2%) preparations. RCC relapses developed in 10 (8.3%) patients; progression in the resection zone was not registered in any case. Five-year overall, cancer-specific, cardiospecific, and disease-free survival were 91.5%, 95.2%, 93.9%, and 91.5%, respectively. The tumor had the structure of renal cell cancer (RCC) in 121 (99.2%) drugs . RCC relapses developed in 10 (8.3%) patients; progression in the resection zone was not registered in any case. Five-year overall, cancer-specific, cardiospecific, and disease-free survival were 91.5%, 95.2%, 93.9%, and 91.5%, respectively.

Conclusions: kidney resection is an effective and relatively safe method for treating patients with tumors of the renal parenchyma with a nephrometric index of PADUA ≥8 and / or RENAL ≥7.

For citation: Volkova M.I., Ridin V.A., Cherniayev V.A., Klimov A.V., Figurin K.M., Matveev V.B. Results of kidney resection in patients with renal cell cancer with a high nephrometric index. Experimental and clinical urology 2019;(3):60-71

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