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1.
Article | IMSEAR | ID: sea-212982

ABSTRACT

Bilateral renal tumors remain relatively uncommon, accounting for 1-5% of patients with renal cell carcinoma. Most sporadic renal cell carcinomas are unilateral and unifocal. Bilateral involvement can be synchronous or asynchronous and is found in 2-4% of sporadic renal cell carcinomas. We report a case of 70 years old male who was incidentally found to have bilateral renal masses. Right sided radical nephrectomy and left partial nephrectomy was performed. Histopathological examination of the specimen revealed clear cell carcinoma and confirmed R0 resection. The patient was discharged on 7th postoperative day.

2.
Chinese Journal of Oncology ; (12): 703-707, 2019.
Article in Chinese | WPRIM | ID: wpr-797951

ABSTRACT

Objective@#To investigate the therapeutic effects of surgical management for local retroperitoneal recurrence of renal cell carcinoma after radical nephrectomy.@*Methods@#Clinical and follow-up data of 33 cases of local recurrence after radical nephrectomy in Renji Hospital from January 2010 to April 2018 were retrospectively analyzed.@*Results@#In these 33 patients, 25 was male and 8 was female; The median age was 54 years old. The pathological stage of radical nephrectomy included 14 cases of pT1-2N0M0 stage, 16 cases of pT3-4 N0M0 stage, and 3 cases of pN1 stage. Only 4 relapsing patients had symptoms, the others were all found to have recurrence by imaging examination during follow up period of postoperation.The median recurrence time for all patients was 30 months, and the median diameter of recurrent tumors was 4.5 cm.Twenty-nine patients underwent complete resection of local recurrent lesions, and 4 patients whose recurrent lesions could not be completely resected converted receive palliative surgery. The median intraoperative blood loss was 500 ml and the median hospital stay after surgery was 4 days. Clavien grade Ⅰ-Ⅱ complications occurred in 5 patients after surgery, and no serious complications of Clavien grade Ⅲ-Ⅴ complications occurred. Six patients received postoperative adjuvant target therapy and distant metastasis occurred in one patient.In the 27 patients without adjuvant target therapy, postoperative distant metastases occurred in 12 patients. The median survival time for all patients after local recurrence surgery was 31 months. The 1-year and 3-year survival rates were 86.8% and 36.9%, respectively.@*Conclusions@#The rigorous imaging examination after radical nephrectomy can detect local recurrent lesions as early as possible in most relapsing patients and imaging examination can predict the integrity of surgical resection of local recurrence.Although intraoperative bleeding of resection of local recurrence is relatively high, the operation is safe and the postoperative complications are controllable. Postoperative adjuvant therapy may also provide better survival benefit for patients with local recurrence.

3.
Article in Chinese | WPRIM | ID: wpr-803127

ABSTRACT

Objective@#To investigate the effect of enhanced recovery after surgery program with thymalfasin in patients undergoing laparoscopic radical nephrectomy in the perioperative period to enhance the quality of rehabilitation and reduce the risk of surgical complications.@*Methods@#Retrospective analysis of the clinical data of 156 patients undergoing radical laparoscopic radical nephrectomy in the People's Hospital of Renshou County from August 2013 to June 2018 was conducted.According to the perioperative management plan, 74 patients were divided into control group(74cases) and observation group(82cases). Laparoscopic surgery was performed in both two groups.The perioperative period of the observation group was accelerated surgical rehabilitation, and thymalfasin was given before and after surgery.The control group used a traditional perioperative management program.The blood loss, postoperative recovery time and complications were compared between the two groups.@*Results@#The loss of hemoglobin during operation[(11.90±5.61)g/L]in the accelerated rehabilitation group was slightly lower than that of the control group[(17.47±5.31)g/L], and the indwelling time of plasma drainage tube, anal exhaust time and hospitalization time in the accelerated rehabilitation group were (35.96±4.47)h, (12.61±4.05)h, (121.45±4.30)h, respectively, which were significantly shorter than those in the control group[(46.81±4.55)h, (15.34±4.45)h, (193.69±5.48)h], the differences were statistically significant (t=6.351, 15.011, 4.012, 92.043, all P<0.05).@*Conclusion@#Enhanced recovery after surgery program with thymalfasin in patients undergoing laparoscopic radical nephrectomy is a safe and effective treatment.The use of thymalfasin method can accelerate the recovery of patients' immune function, and the accelerated rehabilitation program with thymalfasin can effectively reduce the probability of infection during surgery, which can effectively reduce the possibility of infection during operation, accelerate the recovery of physiological function, shorten the hospital stay of patients and improve the quality of rehabilitation of patients.

4.
Chinese Journal of Urology ; (12): 351-355, 2019.
Article in Chinese | WPRIM | ID: wpr-755456

ABSTRACT

Objective To compare the perioperative parameters and renal function in patients,whose aged was 65 year-old or above,with clinical T1-2 renal tumors undergoing partial nephrectomy (PN) or radical nephrectomy (RN).Methods A retrospective review of 469 patients,who underwent RN and PN in our center,was conducted from January 2012 to November 2018,icluding 247 in the RN group and 222 in the PN group.The RN group consisted of 170 male and 77 female patients,with the mean age of (70.96 ± 5.21) year-old.126 cases were found that the tumor located on the fight side,with the median diameter of (4.93 ± 2.03) cm.The median BMI,median R.E.N.A.L.score and pre-operation eGFR of the RN group were (24.4 ± 3.1) kg/m2,8.39 ± 1.45) and (80.23 ± 15.14) ml/(min · 1.73 m2),respectively.The PN group consisted of 150 male and 72 female patients,with the mean age of (70.23 ± 4.62) years old.108 patients had tumors on the left side while 114 on the right side,with the median diameter of (3.17 ± 1.41) cm.The median BMI,median R.E.N.A.L score and pre-operation eGFR of the PN group were (23.5 ± 3.2) kg/m2,(6.69 ± 1.81) and (82.83 ± 14.36) ml/(min · 1.73m2),respectively.No statistical difference was noticed in the age,gender,tumor location and BMI between RN group and PN group(P > 0.05).The PN group had smaller tumors and lower R.E.N.A.L.scores than the RN group (P < 0.05).Various parameters were compared between the PN and RN groups,including operative duration,surgical procedure,intraoperative blood loss,perioperative blood transfusion,drainage tube removal time,postoperative duration of hospitalization,pathological results,the renal function immediately after surgery and at 1 month,1 year,2 years,3 years,4 years,5 years after surgery,and the incidence of chronic renal dysfunction.Results Significant differences were found in multiple variables between the two cohorts,such as operative duration [(115.70 ± 39.69) min in RN vs.(132.26 ± 49.02) min in PN],estimated intraoperative blood loss [(45.85 ± 55.93) days in RN vs.(66.60 ± 61.55) ml in PN],drainage tube removal time [(4.38 ± 1.71) days in RN vs.(4.86 ± 1.61) days in PN],duration of postoperative hospitalization [(5.14 ± 1.65) days in RN vs.(5.52 ± 1.32) days in PN] (P < 0.05).Furthermore,higher proportion of RCC was detected in the RN cohort (93.5% in RN vs.86.5 % in PN,P < 0.05).There was no significant difference in perioperative blood transfusion rate between the two cohorts (10.93% vs.9.01%,P > 0.05).Compared with the RN cohort,the PN cohort had higher eGFR immediately after surgery [(74.08 ± 18.31) ml/(min · 1.73m2) vs.(52.58 ± 14.21) ml/(min · 1.73m2)],1 month after surgery [(76.11 ± 18.34) ml/(min · 1.73m2) vs.(53.78 ± 15.03)ml/(min · 1.73m2)] and at the last follow-up [(73.92 ± 18.59) ml/(min · 1.73m2) vs.(52.35 ± 16.13) ml/(min · 1.73m2)] (P < 0.001).Compared with those of the RN cohort,the incidences of eGFR < 45 ml/(min · 1.73m2) of the PN cohort were lower immediately after surgery [9.01% (20/222) vs.31.9% (79/247)],1 month after surgery [7.87% (14/178) vs.27.31% (62/227)],1 year after surgery [8.96% (13/145) vs.38.75% (62/16 0)],2 years after surgery [9.89% (9/91) vs.31.57% (42/133)],3 years after surgery [13.21% (7/53) vs.30.61% (30/98)],4 years after surgery [16.21% (6/37) vs.30.26% (23/76)] and 5 years after surgery [18.18% (4/22) vs.31.11% (14/45)] (P < 0.001).Conclusion The perioperative risk of PN in the treatment of elderly patients aged 65 and above with clinical cT1-2 renal tumor is controllable.PN could better retain renal function for those patients and reduce the risk of postoperative chronic renal insufficiency.

5.
Article in Chinese | WPRIM | ID: wpr-753825

ABSTRACT

Objective To investigate the effect of enhanced recovery after surgery program with thymalfasin in patients undergoing laparoscopic radical nephrectomy in the perioperative period to enhance the quality of rehabilitation and reduce the risk of surgical complications.Methods Retrospective analysis of the clinical data of 156 patients undergoing radical laparoscopic radical nephrectomy in the People's Hospital of Renshou County from August 2013 to June 2018 was conducted.According to the perioperative management plan ,74 patients were divided into control group (74cases) and observation group(82cases).Laparoscopic surgery was performed in both two groups.The perioperative period of the observation group was accelerated surgical rehabilitation ,and thymalfasin was given before and after surgery.The control group used a traditional perioperative management program.The blood loss,postoperative recovery time and complications were compared between the two groups.Results The loss of hemoglobin during operation [(11.90 ±5.61)g/L]in the accelerated rehabilitation group was slightly lower than that of the control group [(17.47 ± 5.31) g/L], and the indwelling time of plasma drainage tube , anal exhaust time and hospitalization time in the accelerated rehabilitation group were (35.96 ±4.47) h,(12.61 ±4.05) h,(121.45 ±4.30) h,respectively,which were significantly shorter than those in the control group [(46.81 ±4.55)h,(15.34 ±4.45)h,(193.69 ±5.48)h], the differences were statistically significant ( t =6.351, 15.011, 4.012, 92.043, all P <0.05 ).Conclusion Enhanced recovery after surgery program with thymalfasin in patients undergoing laparoscopic radical nephrectomy is a safe and effective treatment.The use of thymalfasin method can accelerate the recovery of patients 'immune function, and the accelerated rehabilitation program with thymalfasin can effectively reduce the probability of infection during surgery,which can effectively reduce the possibility of infection during operation ,accelerate the recovery of physiological function,shorten the hospital stay of patients and improve the quality of rehabilitation of patients .

6.
Chinese Journal of Urology ; (12): 407-412, 2018.
Article in Chinese | WPRIM | ID: wpr-709538

ABSTRACT

Objective To analyze the safety and effectiveness of robot-assisted laparoscopic partial nephrectomy(RLPN) for cT2 renal tumors in international multi-centers.Methods This study was conducted to collect information on surgical procedures performed by RLPN and robot assisted laparoscopic radical nephrectomy (RRN) in nineteen international urological centers from January 2012 to December 2017.RLPN were performed in 159 patients (118 males and 41 females),with the average age of (59.3 ± 13.2) years,body mass index(BMI) of (28.7 ± 5.4)kg/m2,preoperative GFR of (77.3 ± 22.1) ml/min.RRN were performed in 219 patients,with the average age of (62.0 ± 12.9) years,BMI of (28.7 ±6.1) kg/m2,preoperative GFR of (71.4 ± 20.3) ml/min.There was no statistical difference between the two groups in gender and BMI.The age of the patients in RLPN group was younger than that in RRN group,and the preoperative GFR was better.The patient's baseline demographics,perioperative data,tumor pathology,oncologic outcomes,and renal function (GFR) were recorded.Results All 378 cases underwent successful surgery.The operation time of RLPN was 150 min(65-353 min),which was shorter than that of RRN [180 min(85-361 min),P < 0.001].The intra-operative blood loss of RLPN was more than that of RRN [150 ml (40-3 000 ml) vs.100 ml (10-1 100 ml),P < 0.001].The incidence of intra-operative complications were not statistically different between the two groups [5.7% (9/159) vs.3.2% (7/219),P =0.240].The incidence of postoperative complications was higher in the RLPN group than that in RRN group [19.5% (31/159) vs.10.5% (23/219),P =0.014],but there was no significant difference in the incidence of complications of grade 3 or above [4.4% (7/159) vs.2.3% (5/219),P =0.246].The recurrence-free survival rate of RLPN group was higher than that of RRN group [91.4% (117/128) vs.81.9% (167/204),P =0.013],and RLPN group was more conducive to renal function protection (P < 0.001).Conclusions RLPN for cT2 tumors can obtain effective tumor control rate and better renal function preservation.It could be an acceptable alternative for surgical management of cT2 tumors.

7.
Journal of Medical Postgraduates ; (12): 485-489, 2018.
Article in Chinese | WPRIM | ID: wpr-700858

ABSTRACT

Objective There are few clinical cases of mucinous tubluar and spindle cell carcin oma (MTSCC).The article aimed to explore its clinical features and prognosis in order to raise awareness of the disease . Methods A retrospective analysis was conducted on the clinical data of 12 patients with renal MTSCC from June 2009 to June 2017.All the patients were treated with unilater-al radical nephrectomy or enucleation .After discharge, the patients were regularly reviewed or followed up by telephone . Results Of the 12 patients with renal MTSCC, 8 were female, 4 were male, 10 were atypical and 1 was atypical (oligominal tubule), all of them were treated with surgery, one of them lost contact, and the remaining 11 patients had good prognosis. Conclusion Renal MTSCC is a rare form of renal cancer, which is more common in females.The imaging data show that there is no blood supply for renal tumors . Renal MTSCC has a good prognosis , with no recurrence or metastasis, and surgical resection is still the preferred treatment .All the 12 patients with renal MTSCC are in early pathological stage with good prognosis , indicating that renal MTSCC may be a low -grade malig-nancy with good prognosis .

8.
Article in Chinese | WPRIM | ID: wpr-697301

ABSTRACT

Objective To explore the effect of accelerated rehabilitation surgical nursing on perioperative period of laparoscopic radical nephrectomy. Methods A total of 78 patients with laparoscopic radical nephrectomy in Heze City Hospital in Shandong Province from December 2015 to December 2017 were divided into research group and control group with 39 cases each by random digits table method. The control group was received traditional perioperative nursing intervention, the research group was given accelerate rehabilitation surgical nursing in addition to the traditional perioperative nursing. The indicators related to the operation, postoperative complications and postoperative Visual Analogue Scale (VAS) score were compared. In addition, the scores of Self-rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS) before and after nursing in the two groups were compared, and the nursing satisfaction rates of the two groups were compared. Results The first time to go out of bed, anus exhaust time, eating time, length of hospital stay, postoperative hospitalization expenses respectively was (4.82±0.43) h, (6.45±1.93) h, (2.53±0.41) h, (3.59±0.23) d, (3.12±0.15) ten thousand yuan in the research group, and (7.57±0.62) h, (32.67±14.59) h, (27.63±10.64) h, (8.54±0.52) d, (4.57±0.26) ten thousand yuan in the control group, with statistically significant differences between the two groups (t=-54.367--11.126, all P<0.01). The VAS score was (3.63 ± 0.29) points in the research group, and (7.52 ± 0.34) points in the control group, with statistically significant differences between the two groups (t=-54.362, P<0.01). The incidence of postoperative complications was 2.56% (1/39) in the research group, and 10.26% (4/39) in the control group, with statistically significant differences between the two groups (χ2=4.942, P<0.05). Before and after nursing, SAS and SDS scores was respectively (56.37±5.59), (42.35±2.89), (57.30±5.74), (43.09±3.25) points in the research group, and (56.49±5.70), (50.46±4.25), (57.23±5.68), (50.71±5.20) points in the control group, with statistically significant differences between the two groups (t=-9.854,-7.760, all P<0.01). The satisfaction rate of patients was 97.44%(38/39) in the research group, and 84.62%(33/39) in the control group, with statistically significant differences between the two groups (χ2=10.064, P<0.01). Conclusions For patients with laparoscopic radical renal resection, accelerate rehabilitation the use of surgical nursing is of great significance, to reduce the incidence of complications, shorten patients with postoperative hospital stay, reduce pain, eliminate the adverse psychological aspects and so on all play a positive role, further improve nursing satisfaction, promote the postoperative rehabilitation, clinical significance and application value.

9.
Article in English | WPRIM | ID: wpr-56114

ABSTRACT

This study aimed to determine patients with T1b renal cell carcinoma (RCC) who could benefit from partial nephrectomy (PN) and method to identify them preoperatively using nephrometry score (NS). From a total of 483 radical nephrectomy (RN)-treated patients and 40 PN-treated patients who received treatment for T1b RCC between 1995 and 2010, 120 patients identified through 1:2 propensity-score matching were included for analysis. Probability of chronic kidney disease (CKD) until postoperative 5-years was calculated and regressed with respect to the surgical method and NS. Median follow-up was 106 months. CKD-probability at 5-years was 40.7% and 13.5% after radical and PN, respectively (P = 0.005). While PN was associated with lower risk of CKD regardless of age, comorbidity, preoperative estimated renal function, the effect was observed only among patients with NS ≤ 8 (P < 0.001) but not in patients with NS ≥ 9 (P = 0.746). Percent operated-kidney volume reduction and ischemia time were similar between the patients with NS ≥ 9 and ≤ 8. In the stratified Cox regression accounting for the interaction observed between the surgical method and the NS, PN reduced CKD-risk only in patients with NS ≤ 8 (hazard ratio [HR], 0.054; P = 0.005) but not in ≥ 9 (HR, 0.996; P = 0.994). In T1b RCC with NS ≥ 9, the risk of postoperative CKD was not reduced following PN compared to RN. Considering the potential complications of PN, minimally invasive RN could be considered with priority in this subgroup of patients.


Subject(s)
Carcinoma, Renal Cell , Comorbidity , Follow-Up Studies , Humans , Ischemia , Methods , Nephrectomy , Propensity Score , Renal Insufficiency, Chronic
10.
Chinese Journal of Urology ; (12): 529-532, 2016.
Article in Chinese | WPRIM | ID: wpr-496661

ABSTRACT

Objective To explore the operating skills of finding and dissecting renal pedicle in retroperitoneosocpic radical nephrectomy.Methods From April 2011 to April 2015,224 patients with renal tumors were treated by retroperitoneosocpic radical nephrectomy.Along the ureteral ascending methodis used to find renal pedicle for 126 cases(the research group):First found ureter in the iliac crest,the ureter was nearest psoas major here and waseasy to find.Along the ureteral upward until to the renal pelvis and the superior border of renal pelvis is the renal pedicle.77 male and 49 female cases,Age 42 to 84 years,(56.6 ± 9.0) years old on average.Sixty-nine tumors were located in left kidney,and 59 in the right kidney.The mean diameter of renal tumor was(5.3 ± 1.1)cm.There were 25 cases of T1a N0 M0,75 T1b N0 M0,23 of T2 N0 M0,3 of T1bN1M0.Over the same period uplift in he kidney central method is used to find renal pedicle for 98 cases.64 male and 34 female cases,Age 27 to 81 years,(57.9 ± 8.3)years old on average.52 tumors were located in left kidney,and 46 in the right kidney.The mean diameter of renal tumor was (5.5 ± 1.4)cm.There were 19 cases of T1aN0M0,61 T1bN0M0,16 of T2N0M0,2 of T1bN1 M0.Results The differences were significant for Looking for renal pedicle time(2.2 ± 1.1 vs.4.5 ±2.0) min,operation time (73.7 ±67.3 vs.90.1 ±87.5)min,hemorrhage volume(69.8 ±42.7 vs.89.7 ±89.2) ml,the incidence of complications (3 vs.9) between the study group and the control group (P < 0.05).The difference were not significant in postoperative hospital stay (7.5 ± 0.8 vs.7.3 ± 0.8) d,exhaust time (2.1 ± 0.6 vs.2.2 ± 0.6) d between two group.All the operations were performed successfully in the research group,with no conversion to open and transfusion.Major complications included 3 cases of vessel injury.Hemostasis was performed with metal clips and suture.In the control group,ena cava rupture in 3 cases,left lumbar veins rupture in 3 cases,retroperitoneal hematoma in 2 case,mild pulmonary embolism in 1 case.two case performed open operation owing to vena cava rupture.The vena cava rupture transit open surgery in 2 cases,and Hemostasis was performed with metal clips in 1 case of vena cava rupture and on the left side of the lumbar veins rupture was managed by suture,titanium clips and bipolar electrocautery;Retroperitoneal hematoma improved by conservative treatment;Pulmonary embolism improved by medical consultation after thrombolysis.Conclusions Retroperitoneosocpic radical nephrectomy with the method of along the ureteral ascending was safe and could quickly locate and ligate the renal pedicle,and shorten operation time,reduce postoperative complications.

11.
Rev. chil. cir ; 67(6): 635-637, dic. 2015. ilus
Article in Spanish | LILACS | ID: lil-771607

ABSTRACT

Background: Angiomyolipomas associated with tuberous sclerosis may invade the renal vein and generate intramural thrombi. Case report: We report a 36-years-old woman, consulting for left flank pain. CT scan showed a large tumor in the left kidney consistent with the diagnosis of infiltrating renal angiomyolipoma with tumor invasion of the vein. Laparoscopic nephrectomy was performed, with removal of tumor thrombus. The operative time was 127 minutes and estimated bleeding 20 ml. There were no intraoperative or postoperative complications. The patient is currently asymptomatic after 12 months of follow up. The pathological study of the surgical piece showed a renal angiomyolipoma with invasion of the kidney and a solid tumor in the lumen of the renal vein.


Objetivo: Se presenta el caso clínico de un Angiomiolipoma renal con extensión a vena renal, patología de muy baja frecuencia. Caso clínico: Mujer de 36 años, quien consulta por dolor en flanco izquierdo. En una tomografía computada se encuentra una lesión tumoral extensa del riñón izquierdo compatible con un Angiomiolipoma renal infiltrante e invasión tumoral de la vena renal. Se realiza nefrectomía laparoscópica, con extirpación de trombo tumoral. El tiempo operatorio fue de 127 min y el sangrado estimado de 20 ml. No hubo complicaciones intra ni postoperatorias. La paciente se encuentra actualmente asintomática luego de 12 meses de seguimiento. La histología mostró un Angiomiolipoma renal con invasión del riñón y un tumor sólido en el lumen de la vena renal. Conclusión: La invasión de vena renal por un Angiomiolipoma es extremadamente raro. Su resolución laparoscópica es posible, con sólo una comunicación previa en la literatura.


Subject(s)
Humans , Adult , Female , Angiomyolipoma/surgery , Laparoscopy , Nephrectomy/methods , Kidney Neoplasms/surgery , Renal Veins/surgery , Angiomyolipoma/pathology , Neoplasm Invasiveness , Kidney Neoplasms/pathology , Renal Veins/pathology
12.
Chinese Journal of Urology ; (12): 326-329, 2014.
Article in Chinese | WPRIM | ID: wpr-446789

ABSTRACT

Objective To compare the safety and efficiency of retroperitoneal laparoscopic and transperitoneal laparoscopic radical nephrectomy by meta-analysis.Methods A systematic review of the literature about laparoscopic radical nephrectomy was performed,searching Medline,Embase,Cochrane library,CBM,CNKI,VIP and Wan Fang database from January 2000 to October 2012.The key words were transperitoneal,retroperitoneal,laparoscopy,radical nephrectomy.Two researchers evaluated the quality of included studies.A meta-analysis was conducted using Review Manager 5.0 software.Results Nine controlled clinical studies were concluded,including 1 306 patients (520 in retroperitoneal group and 786 in transperitoneal group).The extracted data were comparable.Meta-analysis results showed that significant difference existed in operative time and complication rate (OR =16.23,95% CI 1.62,30.84; OR =2.44,95%CI 1.35,4.41) (P<0.05).It seemed that the retroperitioneal laparoscopic radical nephrectomy was prior to the transperitoneal laparoscopic radical nephrectomy in those items.There was no significant difference between transperitoneal and retroperitioneal laparoscopic radical nephrectomy in incision length,estimated blood loss,stay-in hospital,conversion rate,5-year disease-free survival and 5-year overall survival (P> 0.05).Conclusions Retroperitoneal laparoscopic radical nephrectomy demonstrated significant lower operative time and complication rate than those in transperitoneal laparoscopic radical nephrectomy.However,there is no significant difference in efficacy.Each center can choose a modality according to their convention.

13.
Chinese Journal of Urology ; (12): 433-437, 2014.
Article in Chinese | WPRIM | ID: wpr-451535

ABSTRACT

Objective To investigate the incidence of renal dysfunction among patients received radical nephrectomy during 5-year follow-up and to discover the risk factors for chronic kidney dysfunction (CKD).Methods Data of 339 patients who underwent radical nephrectomy for renal cell carcinoma between Jan.2006 to Dec.2007 were investigated,and those who suffered renal dysfuntion before surgery or lost follow-up were excluded.Finally,148 patients were enrolled in this retrospective study.GFR after surgery were replaced by eGFR which were calculated with the abbreviated equation of MDRD.It will be defined as CKD when eGFR was less than 60 ml/(min · 1.73 m2).Postoperative occurence rate of CKD was estimated using the Kaplan-Meier methods.Rank sum test and chi-square test were used for the univariate analysis in term of CKD between groups.Multivariate Logistic regression analysis was used to judge the independent risk factors for CKD.Results Patients were followed up for 42-60 months.CKD occurred in 58 cases,and the 5 year cumulative incidence of CKD was 42.7%.As many as 17.4% of the patients with a normal eGFR during the first 3 months follow-up would progress to CKD 5 years later.Clinical characteristics,including age at surgery,weight,body mass index,hypertension,preoperative total GFR and contralateral GFR,complications,size of tumor,pathologic type,eGFR calculated shortly after operation,were significantly different between the CKD group and the normal group (P<0.05).Multivariate Logistic regression analysis shows that age at surgery (P =0.016,OR =1.106),size of tumor (P =0.048,OR =0.680) and eGFR calculated within one week postoperatively (P=0.002,OR=0.874) were the independent risk factors for postoperative CKD.Conclusions The incidence of CKD after radical nephrectomy in patients with renal cell carcinoma is not uncommon.The of age at surgery,size of tumor and eGFR value calculated within one week postroperatively have a close relation with the incidence of postoperative CKD.

14.
Chinese Journal of Urology ; (12): 429-432, 2014.
Article in Chinese | WPRIM | ID: wpr-451510

ABSTRACT

Objective To analyze the characteristics of adrenal metastasis from renal cell carcinoma (RCC),and explore the principles to deal with the ipsilateral adrenal gland during radical nepbrectomy.Methods The data of adrenal metastasis in 19 patients with RCC from January 2003 to December 2012 was retrospectively analyzed,including 8 cases with ipsilateral adrenal metastasis,5 with contralateral adrenal metastasis,and 6 with bilateral adrenal metastasis,respectively.The relationship between RCC location,diameter,TNM stage and adrenal metastases was evaluated,and the clinical features of adrenal metastasis were summarized.Results Diameters of RCC ranged from 1.6 cm to 12.6 cm in the 19 cases,and the average diameter was 6.3 cm.The mean diameter of primary RCC,metastasized to the ipsilateral,contralateral and bilateral adrenal gland,was 5.6,6.5 and 7.1 cm,respectively.Among the 9 patients whose primary RCC located in the upper pole,the number of patients with bilateral,ipsilateral and contralateral adrenal metastasis was 3,3,3,respectively.Of the 7 patients with RCC located in the middle and lower pole,the number of patients with bilateral,ipsilateral and contralateral adrenal metastasis was 3,2,2,respectively.Three patients with diffused RCC in the whole kidney occurred ipsilateral adrenal metastases.RCC and adrenal metastasis were simultaneously found in 9 patients,with the average diameter of the primary RCC of 7.4 cm and the clinical stage of T2b-4N0-1 M1.Adrenal metastasis were found in 10 patients during the postoperative follow-up,with the average diameter of the primary RCC of 5.3 cm and the clinical stage of T1a-4N0M0.Nine patients underwent surgery,8 received non-surgical treatment,and 2 had no treatment.Fourteen patients had an average follow-up of 31.9 months,with 1,3 and 5-year survival rates of 84.2%,26.3% and 15.8%,respectively.Conclusions Adrenal metastasis from RCC may be associated with the diameter and TNM of the primary tumor,regardless of the location.For the patients with normal adrenal gland observed in pre-operative imaging,ipsilateral adrenalectomy is not recommended.

15.
Article in Chinese | WPRIM | ID: wpr-436670

ABSTRACT

Objective To explore the clinical effect of laparoscopic radical nephrectomy by retroperitoneal in 65 cases.Methods 65 patients who received retroperitoneal laparoscopic radical nephrectomy were selected as the observation group,and their clinical data were analyzed.At the same period,S0 patients treated by open operation were selected as the control group.The clinical effect was compared between the two groups.Results The operation time,intraoperative blood loss,hospital stay,incision infection,pulmonary infection,hypercapnia,intestinal injury of observation group were lower than those of control group (t =7.60,8.38,8.83,x2 =8.33,6.19,4.08,4.08,all P <0.05).The positive margin rate,local recurrence rate,distant metastasis rate of two groups were not significantly different (P > 0.05).Conclusion Laparoscopic radical nephrectomy by retroperitoneal has advantages of small wound,quicker recovery,less complications and good prognosis,which is worthy of clinical application.

16.
Chinese Journal of Urology ; (12): 185-187, 2012.
Article in Chinese | WPRIM | ID: wpr-425053

ABSTRACT

Objective To evaluate the effect of auxiliary trocar located on various positions on obese patients treated with retroperitoneoscopic radical nephrectomy.MethodsRetrospective analysis was performed for 61 consecutive obese patients who underwent retroperitoneoscopic radical nephrectomy for localized renal cell carcinoma at our institution from March 2004 to December 2010.An auxiliary trocar was placed into retroperitoneal space according to the position of tumor.It was placed infro-costal magin in the mid-axillary line with uppre-median pole tumor,and 4 cm medial to mid-axillary line and 1 cm cephalad to illac spine with lower-median pole,respectively.ResultsAll 61 patients were completed successfully with no conversion to open surgery.Mean operating time was ( 153.1 ± 23.5 ) min.Mean estimated blood loss was (57.6 ±29.7) ml.Mean hospital stay after operation was (5.7 ±2.6) d.The rupture of peritoneum and liquefaction of fat were occurred in 5 and 4 patients respectively.There was no major intraoperative and postoperative complications occurred.Conclusions Reasonable position of the auxiliary trocar according to the tumor's location would be safe and feasible on obese patients treated with retroperitoneoscopic radical nephrectomy.Obese patients with localized renal cell carcinoma would better benefit from minimally invasive procedure.

17.
Article in Chinese | WPRIM | ID: wpr-839648

ABSTRACT

Objective: To compare the efficacy of laparoscopic radical nephrectomy(LRN) and open radical nephrectomy (ORN) for clinical stage T2 renal cell carcinoma. Methods: A total of 138 patients underwent radical nephrectomy for renal cell carcinoma, including 63 by LRN and 75 by ORN. Renal cell carcinoma was pathologically confirmed in all the patients. The patients were followed up for 5-36 months, with a median of 24 months. The surgical blood loss, operation time, and time of starting food postoperatively, and hospital stay were compared between the two groups. Results: The operation tíme was 90- 385 min (a mean of [213 ± 61. 6] min) for LRN and 55-320 min (a mean of [173 ± 52. 3] min)for ORN (P = 0. 000). The blood losswas 30-1 600 ml (a mean of [220±291. 8] ml) for LRN and 50-1 400 ml (a mean of [319 ±244. 1] ml) for ORN (P = 032). The fasting period of surgery was 1-4 d (a mean of [2. 4±0. 82] d) for LRN and 2-5 d (amean of [3. 1±1. 02] d) for ORN(P = 0. 000). The hospital stay was 4-15 d (a mean of [7. 3±2. 50] d) for LRN and 6-15 d (amean of [9. 3±2. 25] d) for ORN (P = 0. 000). Conclusion: The efficacy of LRN is similar to that of ORN. LRN has the advantages of minimal invasiveness and rapid postoperative recovery. The complication of LRN is similar to ORN, and it might be an alternative treatment for clinical T2 stage renal cell carcinomas.

18.
Article in Chinese | WPRIM | ID: wpr-840141

ABSTRACT

To compare different methods for blockage of renal artery in transperitoneal laparoscopic radical nephrectomy, and evaluate the safety and feasibility of direct access to the renal artery. Methods From May 2008 to December 2010, 64 patients with T1N0M0-T2N0M0 stage renal carcinoma underwent transperitoneal laparoscopic radical nephrectomy using a standard procedure to isolate and block renal artery (group A, 33 patients) or a direct access to the renal artery via ligament of Treitz (left side) or aorta-inferior vena cava (right side; group B, 31 patients). The age, gender, body mass index (BMI), history of previous abdominal surgery, tumor side, tumor maximum diameter, and preoperative TNM stages were all matchable between the two groups. Results One patient in group A was conversed to open surgery due to extensive perirenal adhesion and the others successfully received transperitoneal laparoscopic radical nephrectomy. The operation time, estimated blood loss, intraoperative and postoperative complications, postoperative TNM stage, postoperative fasting time, postoperative indwelling time of drainage tube, postoperative hospital stay and pathological types were similar between the two groups. Patients with T2 stage tumors in Group B had less intraoperation blood loss than those in Group A (P<0.05). Conclusion Direct access to the renal artery is feasible and safe of transperitoneal laparoscopic radical nephrectomy. The method not only fulfils the tumor-free principles and reduces intraoperative blood loss, but also broadens the indications of laparoscopic operations for renal cell carcinoma.

19.
Article in Chinese | WPRIM | ID: wpr-839964

ABSTRACT

To compare clinical outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for renal cell carcinoma (RCC) and to identify the indicators for each approach. Methods A total of 258 patients underwent transperitoneal(n=116) or retroperitoneal (n=142) laparoscopic radical nephrectomy for RCC. The operation time, blood loss during operation, fasting period after surgery and hospital stay were compared between the two groups. Results The operation time was 80-315 min(a mean of [167±66.8] min) for transperitoneal approach and 85-280 min(a mean of [152± 48.8] min) for retroperitoneal approach (P=0.034). The blood loss was 50-1,000 ml (a mean of [181±140.4] ml) for transperitoneal approach and 50-800 ml(a mean of [171±132.9] ml) for retroperitoneal approach(P=0.544). The fasting period of surgery was 1-5 d (a mean of [2.8±1.3] d) for transperitoneal approach and 1-5 d (a mean of [2.9±1.2] d) for retroperitoneal approach(P=0.801). The hospital stay was 3-9 d (a mean of [6.6±1.5] d) for transperitoneal approach and 3-8 d (a mean of [6.5±1.6] d) for retroperitoneal approach(P = 0. 477). Conclusion Transperitoneal and retroperitoneal approaches both can yield satisfactory surgical outcomes in laparoscopic radical nephrectomy. The transperitoneal approach is suitable for tumors with a larger size.

20.
Article in Chinese | WPRIM | ID: wpr-839959

ABSTRACT

Objective To compare clinical outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for renal cell carcinoma (RCC) and to identify the indicators for each approach. Methods A total of 258 patients underwent transperitoneal (n = 116) or retroperitoneal (n = 142) laparoscopic radical nephrectomy for RCC. The operation time, blood loss during operation, fasting period after surgery and hospital stay were compared between the two groups. Results The operation timewas 80-315 min (a mean of [167 ±66. 8] min) for transperitoneal approach and 85-280 min (a mean of [152± 48.8] min) for retroperitoneal approach (P = 0. 034). The blood loss was 50-1,000 ml (a mean of [181±140. 4] ml) for transperitoneal approach and 50-800 ml (a mean of [171 ± 132. 9] ml) for retroperitoneal approach(P = 0. 544). The fasting period of surgery was 1-5 d (a mean of [2. 8±1. 3] d) for transperitoneal approach and 1-5 d (a mean of [2. 9 ±1. 2] d) for retroperitoneal approach(P = 0. 801). The hospital stay was 3-9 d (a mean of [6. 6±1. 5] d) for transperitoneal approach and 3-8 d (a mean of [6. 5±1. 6] d) for retroperitoneal approach(P = 0. 477). Conclusion Transperitoneal and retroperitoneal approaches both can yield satisfactory surgical outcomes in laparoscopic radical nephrectomy. The transperitoneal approach is suitable for tumors with a larger size.

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