Abstract:
INTRODUCTION:In patients with localised renal cell carcinoma, the only curative treatment option is surgical tumour excision. The aim of this study was to evaluate peri- and postoperative outcomes as well as oncologic and functional long-term results following surgical treatment of patients with renal cell carcinoma (pT1/pT2) at a tertiary referral centre. PATIENTS AND METHODS:This retrospective study included a total of 758 patients with localised renal cell carcinoma (pT1 /pT2), who underwent radical (RN) or partial (PN) nephrectomy between 01/2008 and 10/2014. Pre-, peri- and postoperative parameters were recorded. Oncologic and functional long-term data were retrieved through questionnaires and structured telephone interviews. RESULTS:Laparoscopic RN or PN resulted in less blood loss and lower peri- and postoperative complication rates compared to open procedures. Regarding short- and long-term renal function, a higher increase in serum creatinine levels was detected after RN. No difference was noted in health status and quality of life. Median follow-up was 36 months. A total of 10.4 % of patients died during follow-up. 4.7 % and 8.4 % developed a relapse or metastatic disease. No difference was found between laparoscopic and open RN/PNs in terms of oncologic long-term results. DISCUSSION:In conclusion, all surgical techniques evaluated in this study provided good oncologic and functional short-/long-term outcomes. EINLEITUNG:Für lokalisierte Nierenzellkarzinome (NZK) stellt die chirurgische Entfernung den einzigen kurativen Therapieansatz dar. Ziele der vorliegenden Arbeit waren die retrospektive Untersuchung peri- und postoperativer Verläufe sowie die Erhebung des onkologischen und funktionellen Langzeitverlaufes in Abhängigkeit vom angewandten operativen Verfahren bei Patienten mit NZK im Stadium pT1/pT2. PATIENTEN UND METHODEN:Insgesamt wurden 758 Patienten mit NZK im Stadium pT1/pT2 eingeschlossen, die zwischen 01/2008 und 10/2014 eine radikale (RN) bzw. partielle Nephrektomie (PN) an der Klinik für Urologie der Charité – Universitätsmedizin Berlin erhielten. Prä-, peri-, und postoperative Parameter wurden retrospektiv aus elektronisch gespeicherten Dokumenten des Klinikinformationssystems erhoben. Die Erhebung der onkologischen (Frage nach Rezidiv, Metastasierung bzw. Gesamtüberleben) und funktionellen (Nierenfunktion im Langzeitverlauf, Evaluation der Lebensqualität mittels QLQ-C30 Fragebogen) Nachsorgedaten erfolgte mit postalisch zugesandten Patientenfragebögen, strukturierten Telefoninterviews und Abfragen der Sterberegister der Einwohnermeldeämter. Die statistische Auswertung erfolgte deskriptiv. Zur Berechnung des progressionsfreien, metastasenfreien und Gesamt-Überlebens wurden Kaplan-Meier Analysen angewandt. ERGEBNISSE:Die Ergebnisse der peri- und postoperativen RN/PN-Datenauswertung zeigten für laparoskopisch durchgeführte Verfahren gegenüber den offenen Verfahren einen geringeren Blutverlust sowie niedrigere peri- und postoperative Komplikationsraten. Die funktionellen Kurz- und Langzeitergebnisse der Nierenfunktion zeigten nach RN einen höheren Anstieg des Serumkreatinins und eine stärkere Abnahme der glomerulären Filtrationsrate (eGFR). Kein Unterschied zeigte sich im Gesundheitszustand bzw. in der Lebensqualität. Das mediane Follow-up betrug 36 Monate und konnte in 65,8 % der Fälle durchgeführt werden. Insgesamt verstarben 10,4 % der Patienten. 4,7 % der Patienten entwickelten ein Rezidiv, bei 8,4 % trat eine Metastasierung auf. Onkologische Langzeitergebnisse zeigten keinen Unterschied zwischen dem laparoskopischen und offenen Verfahren für jeweils RN/PN. DISKUSSION:Zusammenfassend stellten alle chirurgischen Verfahren, die in dieser Arbeit untersucht wurden, sichere Therapieverfahren mit guten onkologischen und funktionellen Kurz- und Langzeitergebnissen dar. Laparoskopische operative Verfahren zeigten niedrigere intra- und postoperative Komplikationsraten im Vergleich zu offenen Verfahren. Weiterhin konnte kein signifikanter Unterschied hinsichtlich des Gesamtüberlebens und der Lebensqualität im Follow-up zwischen ORN und LRN bzw. OPN und LPN nachgewiesen werden.
journal_name
Aktuelle Uroljournal_title
Aktuelle Urologieauthors
Ralla B,Buhl S,Goranova I,Maxeiner A,Friedersdorff F,Magheli A,Hinz S,Fuller TF,Miller K,Busch Jdoi
10.1055/s-0043-118799subject
Has Abstractpub_date
2020-06-01 00:00:00pages
290-298issue
3eissn
0001-7868issn
1438-8820journal_volume
51pub_type
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