Results of kidney resection in patients with renal cell cancer with a high nephrometric index
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% Cl: 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.