Regions included in the NIH-AARP Diet and Health Study

Transcript Regions included in the NIH-AARP Diet and Health Study

Up to Date Câncer de rim tratamento minimamente invasivo

Álvaro Sarkis Professor Livre Docente Universidade de São Paulo Urologista do Hospital do Servidor Público de São Paulo

Outline

• Nefrectomia minimamente invasiva vs aberta para tumores 4cm a 7cm • Crioablação laparoscópica vs PN para tumores renais pequenos: revisão sistemática • Evolução funcional e oncológica de NSS para tumores renais >7 cm

Nefrectomia minimamente invasiva vs aberta para tumores 4cm a 7cm

MSKCC N=280 de 2290

Seguimento livre de recidivas e metástases Mediana de follow-up para OPN 29 meses e MIPN 13 mo, Seguimento curtoi!!

EUROPEAN UROLOGY 61 (2012) 593 –599

Nefrectomia parcial para Tumores > 4 cm

EUROPEAN UROLOGY 61 (2012) 593 –599

9()% das nefrectomias não são parciais EUROPEAN UROLOGY 61 (2012) 593 –599

Conclusão

• LPN pode ser feita com segurança em tumores > 4 a 7cm, com aumento de morbidade (fistula 7% laparoscopia vs 5% aberta)

Crioablação laparoscópica vs PN para tumores renais pequenos revisão sistemática

EUROPEAN UROLOGY 60 (2011) 435 –443

Crioablação laparoscópica vs PN para tumores renais pequenos

EUROPEAN UROLOGY 60 (2011) 435 –443

Crioablação laparoscópica vs PN para tumores renais pequenos

EUROPEAN UROLOGY 60 (2011) 435 –443

Conclusões

• LCA e PN são opções viáveis para o tratamento de SRMs • LCA tem maior risco de progressão local • PN é "gold standard"

Evolução funcional e oncológica de NSS para tumores renais >7 cm

EUROPEAN UROLOGY 5 9 ( 2 0 1 1 ) 9 3 1 – 9 3 7 avai l abl e at w w w .sci encedi r ect .co m j our nal homepage: w w w .eu r opeanur ol ogy.com

Platinum Priority – Kidney Cancer Editorial by Craig G. Rogers on pp.

938–939 of this issue Short -Term Functional and Oncologic Outcomes of Nephron-Sparing Surgery for Renal Tumours I 7 cm Frank Becker a , b , 1 , Frederik C. Roos c , 1 , * , Martin Janssen a , Walburgis Brenner Christian Hampel c , Stefan Siemer a , Joachim W. Thu¨roff c ¨ckle a c , a Department of Urology, University of Saarland, Kirrbergerstrasse, Homburg/Saar, Germany b Boxberg Center, Department of Urology and Group Practice Derouet/Poenicke/Becker, Boxbergweg 3, Neunkirchen/Saar, Germany c Department of Urology, Medical Centre, Johannes Gutenberg University, Langenbeckstr, Mainz, Germany Article info Article history: Accepted February 3, 2011 Published online ahead of pr int on Febr uar y 11, 2011 Keywords: Renal cell carcinoma Surgical treatment NSS Oncologic outcome Complications Please visit www.eu-acme.org/ europeanurology answer questions on-line.

The EU-ACME credits will then be attributed automatically.

to read and Abstract Background: Nephron-sparing surgery (NSS) for renal tumours preserves renal function and has become the standard approach for small renal tumours. Little is known about perioperative and oncologic outcomes of patients following NSSin renal tumours 7 cm in the presence of a healthy contralateral kidney.

Objective: To analyse oncologic outcomes and perioperative morbidity in patients treated by NSSfor renal tumours 7 cm.

Design, setting, and participants: In total, 5767 patients were treated for renal tumours at two institutions from 1984 to 2009. In 91 patients, elective NSSwas performed for renal tumours 7 cm.

Measurements: Complication rates were assessed in detail and stra tiﬁed using the Clavien-Dindo score (CDS). Oncologic outcomes for overall survival (OS), cancer-spec iﬁc survival (CSS),and progression-freesurvival (PFS) wereestimated usingtheKaplan-Meier method. Logisticregression analysiswasused to identify clinical risk factorsfor complica tions and prognosticators that have an oncologic impact on OS.

Results and limitations: The median follow-up was 28 mo (range: 1–247 mo). Twenty seven patients (29.6%) had perioperative complications and, of these, 89.1%had CDS grade 1 and 2.

Twenty-seven percent of the 91 patients had benign lesions. Seven patients (10.6%) died from cancer-related causes. The 5- and 10-yr rates for OS, CSS, and PFSwere 88% and 64%,97%and 83%,and 91%and 78%,respectively. None of the analysed parameters had an impact on morbidity or OSin the univariate analysis. Limitations of this study were its retrospective nature and the relatively short follow-up period for oncologic outcome.

Conclusions: NSSfor renal tumours 7 cm can be performed with acceptable compli cation rates and with oncologic outcomes comparable to radical nephrectomy studies.

Our ﬁndings support NSS whenever technically feasible to reduce the loss of renal function.

1 Equal contribution.

* Correspondi ng author. Department of Urology and Paediatric Urology, Medical Centre, Johannes Gutenberg University, Langenbeckstrasse 1, 55101 Mainz, Germany. Tel. +49 6131 177183; Fax: +49 6131 17 6415.

E-mail address: [email protected]

(F.C. Roos).

5767 patients were treated for renal tumours at two institutions from 1984 to 2009.

In 91 patients, elective NSS was performed for renal tumours > 7 cm.

The median follow-up was 28 mo (range: 1 –247 mo). Twenty- seven patients (29.6%)

Comparavel à cirurgia aberta

Conclusão

• NSS para tumores renais > 7cm é viavel e pode ser sempre feita desde que tecnicamente factível* *proposta dos autores

Conclusões gerais

• LPN pode ser feita com segurança em tumores > 4 a 7cm, com aumento de morbidade (fistula 7% lap. vs 5% aberta) • LCA e PN são opções viáveis para o tratamento de SRMs • LCA tem maior risco de progressão local • PN é "gold standard” • NSS para tumores renais > 7cm é viavel e pode ser sempre feita desde que tecnicamente factível

n addition to a comparable oncological outcome be- tween NSS and RN for renal tumors larger than 4 cm, we have shown that increasing age, ASA score 3 􏰄 4, preop erative eGFR, and RN are associated with the develop- ment of CKD in a balanced cohort for patients treated by NSS or RN for renal tumors 􏰄 4 cm. NSS maintains renal function with comparable perioperative morbidity to RN. It is therefore reasonable to postulate that NSS should be performed, whenever technically feasible.