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The treatment of bilateral Wilms tumors (BWT) involves curing the cancer, preserving long-term renal function, and maintaining a good quality of life. Established methods for achieving these goals include preoperative chemotherapy and nephron-sparing surgery (NSS). This study aimed to evaluate the experience of a single institution in treating patients with BWT. We analyzed cases of BWT treated at the Pediatric Oncology Institute-GRAACC-Federal University of São Paulo over a period of 35 years. Bleeding control was performed with manual compression of the renal parenchyma. Thirty-three patients were included in the study. Thirty cases were synchronous tumors. The mean age at diagnosis was 30.4 months (±22 m) and 66.7% were girls. The median follow-up period was 83 months. Neoadjuvant chemotherapy was the primary approach in most patients (87.9%), with a simultaneous upfront surgical approach performed in 84.8%. Most patients underwent bilateral NSS (70.4%). There were no early complications in this series, but 39.4% had clinical complications. The five-year survival rate was 76%. Therefore, it is clear that the surgical approach to BWT plays a crucial role in achieving good outcomes. However, it is difficult to standardize surgical techniques and technology may have the potential to enhance safety.
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El primer trasplante renal realizado con éxito fue en 1954, y su realización se ha extendido por todo el mundo, las complicaciones postoperatorias no son infrecuentes, estas complicaciones se dividen en tres grupos: Complicaciones vasculares, parietales y urológicas. Las más graves son las de origen vascular entre las que podemos mencionar la estenosis de la arteria o vena renal, trombosis por torsión, anastomosis fallida o hemorragia, en tanto las complicaciones parietales o urológicas son estenosis ureteral, fuga urinaria, colecciones de líquido peritrasplante (hematoma o linfocele). Paciente masculino de 57 años presenta antecedentes de: Enfermedad renal crónica en hemodiálisis desde 2019, se somete a trasplante renal en fecha 08/12/2022, con hallazgos de riñón trasplantado con 4 arterias y 2 venas, presentando al mes de la cirugía datos de sepsis y colección periinjerto, realizadose exploración quirúrgica, evidenciando necrosis de toda la cara posterior del injerto hasta comprometer pelvis renal, con apertura total de la pelvis renal posterior, con fuga de orina, por lo que se realiza desbridación de injerto renal y colocación de pielostomia y catéter JJ, con posterior recuperación de la función renal y aumento de la diuresis. Conclusiones: Las complicaciones quirúrgicas posterior al trasplante renal son frecuentes, y ocurren en un % parte de los pacientes, si bien las complicaciones urológicas como la fuga de orina son infrecuentes y más cuando se produce necrosis a nivel de la pelvis renal, es evidente que se requiere de un manejo oportuno y que existen vatios factores a tomar en cuenta desde un control pretransplante hasta el postoperatorio alejado y así evitar la pérdida del injerto ya que conlleva a un gran deterioro en la vida del paciente.
The first successful kidney transplant was performed in 1954, and its performance has spread throughout the world, postoperative complications are not uncommon, these complications are divided into three groups: Vascular, parietal and urological complications. The most serious are those of vascular origin, among which we can mention stenosis of the renal artery or vein, thrombosis due to torsion failed anastomosis or hemorrhage, while parietal or urological complications are ureteral stenosis, urinary leakage, peritransplant fluic collections ( hematoma or lymphocele).A 57-year-old male patient presents a history of: Chronic kidney disease on hemodialysis since 2019, underwent a kidney transplant on 12/08/2022, with findings of a transplanted kidney with 4 arteries and 2 veins, presenting sepsis data and data a month after surgery. perigraft collection, surgical exploration was performed, evidencing necrosis of the entire posterior face of the graft until compromising the renal pelvis, with total opening of the posterior renal pelvis, with urine leakage, for which debridement of the renal graft and placement of a pyelostomy and catheter is performed JJ, with subsequent recovery of rena function and increased diuresis. Conclusions: Surgical complications after renal transplantation are frequent, and occur in % of patients although urological complications such as urine leakage are rare and more when necrosis occurs at the level of the renal pelvis, it is evident that timely management is required and there are several factors to take into account from a pre-transplant control to the remote postoperative period and thus avoid graft loss since it leads to a great deterioration in the patient's life.
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BACKGROUND: To evaluate demographic, clinical and pathological characteristics of small renal masses (SRM) (≤ 4 cm) in a Latin-American population provided by LARCG (Latin-American Renal Cancer Group) and analyze predictors of survival, recurrence and metastasis. METHODS: A multi-institutional retrospective cohort study of 1523 patients submitted to surgical treatment for non-metastatic SRM from 1979 to 2016. Comparisons between radical (RN) or partial nephrectomy (PN) and young or elderly patients were performed. Kaplan-Meier curves and log-rank tests estimated 10-year overall survival. Predictors of local recurrence or metastasis were analyzed by a multivariable logistic regression model. RESULTS: PN and RN were performed in 897 (66%) and 461 (34%) patients. A proportional increase of PN cases from 48.5% (1979-2009) to 75% (after 2009) was evidenced. Stratifying by age, elderly patients (≥ 65 years) had better 10-year OS rates when submitted to PN (83.5%), than RN (54.5%), p = 0.044. This disparity was not evidenced in younger patients. On multivariable model, bilaterality, extracapsular extension and ASA (American Society of Anesthesiologists) classification ≥3 were predictors of local recurrence. We did not identify significant predictors for distant metastasis in our series. CONCLUSIONS: PN is performed in Latin-America in a similar proportion to developed areas and it has been increasing in the last years. Even in elderly individuals, if good functional status, sufficiently fit to surgery, and favorable tumor characteristics, they should be encouraged to perform PN. Intending to an earlier diagnosis of recurrence or distant metastasis, SRM cases with unfavorable characteristics should have a more rigorous follow-up routine.
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Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/mortalidade , Neoplasias Renais/diagnóstico , Neoplasias Renais/mortalidade , Recidiva Local de Neoplasia/mortalidade , Idoso , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/cirurgia , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , América Latina , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
OBJECTIVE: This study is performed to explore the pathological characteristics and oncologic outcomes of T1 multifocal renal cell carcinoma (RCC). METHODS: The clinical data of 600 patients (442 males and 158 females) between the age of 29 and 73 years, diagnosed with T1 RCC were collected from three hospitals in China, out of which 421 cases had undergone nephron-sparing surgery (NSS) and 179 cases had undergone radical nephrectomy (RN) between December 2010 and January 2015. RESULTS: Tumor was identified with multifocality in 32 patients (5.33%), out of which 21 were set to receive NSS, and 11 to receive RN, respectively; 21 cases of clear cell tumor, 8 cases of papillary tumor, 1 case of chromophobe tumor and 2 cases of Xp.11.2 translocation RCC. Among 568 cases of monofocal tumors, 400 patients underwent NSS, and the remaining 168 patients underwent RN, respectively. After a median follow-up of 5 years, 13 patients were found with recurrent tumors out of those who had undergone NSS, 11 with monofocal tumors and 2 with multifocal tumors containing satellite tumor nodules (p = 0.13). Out of the 32 individuals with multifocal RCC, 4 cases were reported to have died of cancer, 2 of NSS and 2 of RN. From these findings, the cancer-specific survival for NSS and RN was estimated to be 90.48% and 81.82%, respectively (p = 0.48). CONCLUSION: The findings from the study suggested that there were pathological differences in multifocal renal tumors, and that papillary carcinoma may be more common than clear cell carcinoma. The recurrence rate and survival rate of multifocal RCC were similar to monofocal tumors. Tumor recurrence may be related to satellite tumor nodules, which can only be detected once surgery is performed.
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Carcinoma Papilar/mortalidade , Carcinoma de Células Renais/mortalidade , Neoplasias Renais/mortalidade , Nefrectomia/mortalidade , Néfrons/cirurgia , Tratamentos com Preservação do Órgão/mortalidade , Adulto , Idoso , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Feminino , Seguimentos , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
OBJECTIVE: To evaluate the pathological features and define the optimal surgical margins (SM) of nephron-sparing surgery (NSS) for kidney neoplasms 4-7 cm (stage pT1b) on preoperative imaging. MATERIALS AND METHODS: The retrospective study included 748 patients who were diagnosed stage pT1b renal tumors and underwent either radical nephrectomy (RN, n = 475) or NSS (n = 273) from January 2004 to March 2017. The tumor size, pathological subtype, Fuhrman grade, status of peritumoral pseudocapsule (PC) and tumor multifocality were recorded. The relationship between peritumoral PC and positive SM was calculated statistically by Fisher's exact probability test. RESULTS: The mean tumor diameter was 5.4 cm (range: 4.1-7.0 cm), 65 (8.7%) cases were discovered with multifocal lesions and 686 (91.7%) were surrounded with peritumoral PC in all 748 specimens. 57 (8.3%) of 686 cases were proved with tumor infiltrated beyond PC [infiltration (+)], and the presence of PC infiltration (+) was significantly correlated with positive SM (p = 0.016). The infiltrative depth of tumor cells into renal parenchyma beyond PC was all limited in 3 mm and the proportion of ≤ 1, 1-2 and 2-3 mm was 21.1% (12/57), 59.6% (34/57) and 19.3% (11/57), respectively. CONCLUSIONS: Our report indicates a 3 mm excisional margin is acceptable to ensure negative SM when operating NSS on stage pT1b kidney neoplasms.
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Neoplasias Renais/cirurgia , Néfrons/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos RetrospectivosRESUMO
ABSTRACT Objectives: To evaluate functional and oncologic outcomes of partial nephrectomy (PN) in patients with a solitary kidney. Materials and Methods: A retrospective analysis of patients with a solitary kidney undergoing nephron-sparing surgery between March 2003 and March 2013 was performed. GFR was recorded before the procedure and 3 months after surgery, thus establishing a change (cGFR). Several variables that may influence cGFR were analyzed. Complications are herein described, namely bleeding, fistula, acute renal failure and end-stage renal disease (ESRD). Local recurrence and margin status are also described. Survival rates were calculated using the Kaplan Meier method (2 patients with metastasis at the time of surgery were excluded from the analysis). Results: Forty-five patients were available for analysis. Median follow-up was 27.56 months (r 3-96). Mean cGFR was-7.12mL/min (SD 2.1). Variables significantly related with lower GFR after surgery were loss of renal mass (p=0.01)) and male gender (p=0.03). Four patients (8.8%) experienced hemorrhage. Nine patients (20%) developed a urinary fistula. Only one patient with bleeding required open surgery. Two patients (4.4%) needed transient dialysis. Three patients (6.6%) developed ESRD. Four patients (8.8%) had positive surgical margins (PSMs) and four patients (88%) had local recurrence (2 of these had PSMs). Five patients (11.1%) died during follow-up. Four patients (8.8%) died because of renal cancer. Estimated 2-year overall survival, disease-free survival and cancer specific survival rates were 88.4% (CI 95% 70.5-96); 87.7% (CI 95% 68.1-96) and 92.4% (CI 95% 75-98), respectively. Conclusion: Loss of renal mass and male gender were associated with lower postoperative GFR. Our outcomes were comparable with those in the World literature.
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Humanos , Masculino , Feminino , Adulto , Idoso , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Complicações Pós-Operatórias , Período Pós-Operatório , Prognóstico , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Índice de Massa Corporal , Taxa de Sobrevida , Estudos Retrospectivos , Fatores de Risco , Fatores Etários , Estatísticas não Paramétricas , Insuficiência Renal Crônica , Isquemia Fria , Isquemia Quente , Estimativa de Kaplan-Meier , Tratamentos com Preservação do Órgão , Taxa de Filtração Glomerular , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Pessoa de Meia-Idade , Nefrectomia/mortalidadeRESUMO
Kidney cancer is the 13th most common malignancy worldwide with significant increase in Stage I renal cell cancer (RCC). Surgical excision by nephron sparing surgery (NSS) remains the treatment of choice for small renal masses (SRMs). One of the variants of partial nephrectomy is simple enucleation (SE) or tumor enucleation (TE). The present review comments on the indications and technical aspects of SE as well as its outcomes. SE/TE has shown both perioperative and oncologic satisfactory results, comparable to partial nephrectomy (PN). It is a valid technique for SRMs and achieves maximum renal parenchymal preservation with an insignificant impact on renal function.
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Neoplasias Renais/cirurgia , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/patologia , Estadiamento de Neoplasias , Nefrectomia/métodosRESUMO
BACKGROUND: Nephron -sparing surgery is currently the treatment of choice for surgical removal of solid renal tumours smaller than 7 cm, in the case of a solitary kidney, bilateral renal tumours or the presence of chronic renal failure. MATERIAL AND METHODS: An observational, descriptive, retrospective and cross-sectional study was conducted. The variables evaluated were: age at diagnosis, gender, intraoperative blood loss, operative time, preoperative tumour size, hospital stay, pathology report, pTNM classification, Fuhrman nuclear grade, pre- and post-operative creatinine, monitoring for cancer. All were analysed using SPSS v 22. RESULTS: The study included 28 patients, 14 male and 14 women, with a mean age 52.3 years. The approach was lumbotomy in all patients. The mean hospital stay was 4.1 days. Mean perioperative bleeding loss was 380.3 ml. The mean preoperative creatinine was 0.96 mg/dl, with a post-operative mean of 1.12 mg/dl. Histopathology reported, 23 clear cell tumours, 2 angiomyolipomas, 2 oncocytomas, and 1 haemorrhagic cyst. Tumour staging was performed on 14 patients, with 13 patients T1bN0M0, and 1 patient T2aN0M0. In clear cell tumours, Fuhrman nuclear grade 2 was present in 16 patients and 7 patients were Fuhrman grade 3. CONCLUSION: Nephron sparing surgery is the choice procedure of choice in patients with small renal tumours, with good functional results without significant alteration in renal function. Outcome is optimal, with a low incidence of complications.
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Neoplasias Renais/cirurgia , Nefrectomia/métodos , Tratamentos com Preservação do Órgão , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Néfrons , Estudos Retrospectivos , Carga Tumoral , Adulto JovemRESUMO
INTRODUCCIÓN Y OBJETIVO: El mayor uso de imágenes diagnósticas, ha implicado un aumento en el diagnóstico de lesionestumorales renales de menor tamaño, llevando al desarrollo de técnicas quirúrgicas conservadoras de parenquimarenal. Series internacionales han demostrado que los resultados oncológicos de este tipo de cirugía son similares a la nefrectomía radical. Nuestro objetivo es mostrar la experiencia y resultados oncológicos de la cirugía conservadora deparenquima renal. MATERIALES Y MÉTODOS: Estudio retrospectivo, de las nefrectomías parciales y tumorectomías realizadas entre Enero del año 2002 y Junio del año 2013, en el Hospital Clínico Regional de Valdivia. RESULTADOS: 50 pacientes fueron sometidos a cirugía renal conservadora, con 51 cirugías realizadas. 26 corresponden a sexo masculino y 24 a sexo femenino; promedio de edad de 58,2 años. De las cirugías realizadas veinte correspondieron a nefrectomías parciales, contamaño tumoral promedio de 4,3 cms. (2-7 cms.) y 31 a tumorectomías, con tamaño tumoral promedio de 2,5 cms. (1-6,1cms.). Del total de los tumores resecados, ocho (26%) fueron informados como tumores benignos y 43 (84%) corresponden a adenocarcinomas; 41 (95%) corresponden a la variante células claras y solo dos a variante de células cromofobas. Lasbiopsias rápidas están todas entre 1-2 mm de tejido sano como margen, y todas fueron negativas para tumor. La biopsiadiferida, informo cuatro márgenes positivos para tumor. De estas, tres fueron a re-cirugía cuyas biopsias fueron negativaspara tumor. El tiempo promedio de seguimiento fue de 51,1 meses, con una sobrevida actuarial a los diez años cercana al70% y una sobrevida específica a los diez años cercana al 95%...
INTRODUCTION AND OBJECTIVE: The increased use of diagnostic imaging, has involved an increase in the diagnosis ofsmaller tumor lesions, taking the development of conservative surgical techniques of renal parenchyma. Internationalseries have shown that cancer results from this type of surgery are similar to radical nephrectomy. Our goal is to show the experience and oncological results of renal parenchymal sparing surgery. MATERIALS AND METHODS: Retrospective studyof tumorectomies and partial nephrectomies performed between January 2002 and June 2013, at the Regional Hospital ofValdivia. RESULTS: 50 patients underwent renal sparing surgery, with 51 surgeries performed. 26 are male and 24 female,average age of 58.2 years old. Of the surgeries performed, twenty were partial nephrectomy, with average tumor size of4.3 cm. (2-7 cms.) and 31 tumorectomies, with average tumor size of 2.5 cm. (1-6.1 cms.). Of all resected tumors, eight (26%)were reported as benign and 43 (84%) were adenocarcinomas, 41 (95%) were clear cell variant and only two chromophobecell variant. Quick biopsies are all 1-2 mm of healthy tissue margin, and all were negative for tumor. The deferred biopsy,reported four positive tumor margins. Of these, three went to re-surgery, whose biopsies were negative for tumor. The average follow-up time was 51.1 months, with an actuarial survival at ten years about 70% and a specific survival at ten years was approximately 95%...
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Carcinoma/cirurgia , Nefrectomia/métodos , Neoplasias Renais/cirurgia , Análise de Sobrevida , Estudos Retrospectivos , SeguimentosRESUMO
La nefrectomía parcial por laparoscopia es una de las opciones de tratamiento conservador de nefronasutilizada en urología. Es una técnica quirúrgica compleja, que se asocia a mayores riesgos de complicacionesen omparación a otras de las técnicas urológicas. Nuestro objetivo fue revisar la serie, la técnica, las complicaciones operatorias y los resultados oncológicos en nuestra experiencia inicial denefrectomía parcial laparoscópica.Se consignan características epidemiológicas de los pacientes, detalles de la técnica quirúrgica,características de los tumores y resultados anátomo-patológicos de las 26 intervenciones realizadas.No hubo conversión de la técnica en esta revisión y 4 pacientes presentaron complicaciones post operatorias. La biopsia intraoperatoria resultó con bordes negativos en todos los pacientes.Palabras claves: Tumor renal, cirugía renal conservadora, laparoscopia.
Laparoscopic partial nephrectomy is an option of nephron sparing surgery used in urology. It is a complex surgical procedure, which is associated with increased risk of complications compared to other techniques urological. Our objective was to review the series, the technique, the operative complications and oncologic results in our initial experience of laparoscopic partial nephrectomy. We analyzed the epidemiological characteristics of patients, details of surgical technique, characteristics of the tumors and surgical pathology results of 26 surgeries. There was no conversion, but 4 patients had post-operative complications. Intraoperative biopsy was negative in all patients.