Die organerhaltende Nierentumor-Therapie

Zusammenfassung

Für lokal begrenzte Nierentumoren gibt es verschiedene Behandlungsoptionen. Neben der radikalen Tumornephrektomie hat sich die Nierenteilresektion oder Nierentumorenukleationsresektion etabliert. Neue Verfahren wie die Radiofrequenzablation und die Kryotherapie haben das Stadium der experimentellen Therapie verlassen und werden an wenigen Zentren routinemäßig angeboten. Die Ergebnisse der unterschiedlichen Verfahren werden dargestellt. Probleme und Komplikationen werden beurteilt. Ein prospektiv randomisierter Vergleich zwischen den verschiedenen Verfahren liegt nicht vor. Daher ist eine gegenüberstellende Bewertung nicht möglich.

Abstract

In this article up-to-date, nephron-sparing therapy for renal cell cancer such as radical tumor nephrectomy, partial resection or enucleation is summarised. The results of open and laparoscopic partial nephrectomy and tumor enucleation are presented. Problems and complications associated with the techniques are reviewed. There are as yet no randomized, controlled trials and most published studies show retrospective data. Further new alternative techniques in nephon-sparing therapy like cryosurgery and radiofrequency ablation are presented.

Schlüsselwörter

Nierentumoren - Nephrektomie - postoperativer Komplikationen - Patientenauswahl - Kryotherapie

Key words

kidney neoplasms - nephrectomy - postoperative complications - patient selection - cryosurgery

Literatur

• 1 Jayson M, Sanders H. Increased incidence of serendipitously discovered renal cell carcinoma.  Urology. 1998 Feb;  51 (2) 203-205
• 2 Moll V, Becht E, Ziegler M. Kidney preserving surgery in renal cell tumors: indications, techniques and results in 152 patients.  J Urol. 1993 Aug;  150 (2 Pt 1) 319-323
• 3 Ueda T, Yasumasu T, Uozumi J, Naito S. Comparison of clinical and pathological characteristics in incidentally detected and suspected renal carcinoma.  Br J Urol. 1991 Nov;  68 (5) 470-472
• 4 Fergany A F, Hafez K S, Novick A C. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup.  J Urol. 2000 Feb;  163 (2) 442-445
• 5 Lau W K, Blute M L, Weaver A L, Torres V E, Zincke H. Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney.  Mayo Clin Proc. 2000 Dec;  75 (12) 1236-1242
• 6 Patard J J, Shvarts O, Lam J S, Pantuck A J, Kim H L, Ficarra V. et al . Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience.  J Urol. 2004 Jun;  171 (6 Pt 1) 2181-2185, quiz
• 7 Becker F, Siemer S, Hack M, Humke U, Ziegler M, Stockle M. Excellent long-term cancer control with elective nephron-sparing surgery for selected renal cell carcinomas measuring more than 4 cm.  Eur Urol. 2006 Jun;  49 (6) 1058-1063
• 8 Leibovich B C, Blute M L, Cheville J C, Lohse C M, Weaver A L, Zincke H. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy.  J Urol. 2004 Mar;  171 (3) 1066-1070
• 9 Dash A, Vickers A J, Schachter L R, Bach A M, Snyder M E, Russo P. Comparison of outcomes in elective partial vs radical nephrectomy for clear cell renal cell carcinoma of 4 - 7 cm.  BJU Int. 2006 May;  97 (5) 939-945
• 10 Schlichter A, Wunderlich H, Junker K, Kosmehl H, Schubert J. [Limits for organ-preserving surgery in renal cell carcinoma].  Urologe A. 1999 Sep;  38 (5) 479-485
• 11 Brkovic D, Riedasch G, Waldherr R, Rohl L, Staehler G. [Local recurrence after organ saving kidney tumor surgery].  Urologe A. 1994 Mar;  33 (2) 104-109
• 12 Zincke H, Sen S E. Experience with extracorporeal surgery and autotransplantation for renal cell and transitional cell cancer of the kidney.  J Urol. 1988 Jul;  140 (1) 25-27
• 13 Campbell S C, Novick A C, Herts B, Fischler D F, Meyer J, Levin H S. et al . Prospective evaluation of fine needle aspiration of small, solid renal masses: accuracy and morbidity.  Urology. 1997 Jul;  50 (1) 25-29
• 14 Fergany A F, Saad I R, Woo L, Novick A C. Open partial nephrectomy for tumor in a solitary kidney: experience with 400 cases.  J Urol. 2006 May;  175 (5) 1630-1633
• 15 Novick A C, Streem S, Montie J E, Pontes J E, Siegel S, Montague D K. et al . Conservative surgery for renal cell carcinoma: a single-center experience with 100 patients.  J Urol. 1989 Apr;  141 (4) 835-839
• 16 Ghavamian R, Cheville J C, Lohse C M, Weaver A L, Zincke H, Blute M L. Renal cell carcinoma in the solitary kidney: an analysis of complications and outcome after nephron sparing surgery.  J Urol. 2002 Aug;  168 (2) 454-459
• 17 Castilla E A, Liou L S, Abrahams N A, Fergany A, Rybicki L A, Myles J. et al . Prognostic importance of resection margin width after nephron-sparing surgery for renal cell carcinoma.  Urology. 2002 Dec;  60 (6) 993-997
• 18 Piper N Y, Bishoff J T, Magee C, Haffron J M, Flanigan R C, Mintiens A. et al . Is a 1-CM margin necessary during nephron-sparing surgery for renal cell carcinoma?.  Urology. 2001 Dec;  58 (6) 849-852
• 19 Lerner S E, Hawkins C A, Blute M L, Grabner A, Wollan P C, Eickholt J T. et al . Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery.  J Urol. 1996 Jun;  155 (6) 1868-1873
• 20 Rosenthal C L, Kraft R, Zingg E J. Organ-preserving surgery in renal cell carcinoma: tumor enucleation versus partial kidney resection.  Eur Urol. 1984;  10 (4) 222-228
• 21 Abukora F, Nambirajan T, Albqami N, Leeb K, Jeschke S, Gschwendtner M. et al . Laparoscopic nephron sparing surgery: evolution in a decade.  Eur Urol. 2005 Apr;  47 (4) 488-493
• 22 Jeschke K, Peschel R, Wakonig J, Schellander L, Bartsch G, Henning K. Laparoscopic nephron-sparing surgery for renal tumors.  Urology. 2001 Nov;  58 (5) 688-692
• 23 Frank I, Colombo Jr J R, Rubinstein M, Desai M, Kaouk J, Gill I S. Laparoscopic partial nephrectomy for centrally located renal tumors.  J Urol. 2006 Mar;  175 (3 Pt 1) 849-852
• 24 Gill I S, Matin S F, Desai M M, Kaouk J H, Steinberg A, Mascha E. et al . Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients.  J Urol. 2003 Jul;  170 (1) 64-68
• 25 Moinzadeh A, Gill I S, Finelli A, Kaouk J, Desai M. Laparoscopic partial nephrectomy: 3-year followup.  J Urol. 2006 Feb;  175 (2) 459-462
• 26 Gill I S. Retroperitoneal laparoscopic nephrectomy.  Urol Clin North Am. 1998 May;  25 (2) 343-360
• 27 Stephenson A J, Hakimi A A, Snyder M E, Russo P. Complications of radical and partial nephrectomy in a large contemporary cohort.  J Urol. 2004 Jan;  171 (1) 130-134
• 28 Shvarts O, Tsui K H, Smith R B, Kernion J B, Belldegrun A. Blood loss and the need for transfusion in patients who undergo partial or radical nephrectomy for renal cell carcinoma.  J Urol. 2000 Oct;  164 (4) 1160-1163
• 29 Corman J M, Penson D F, Hur K, Khuri S F, Daley J, Henderson W. et al . Comparison of complications after radical and partial nephrectomy: results from the National Veterans Administration Surgical Quality Improvement Program.  BJU Int. 2000 Nov;  86 (7) 782-789
• 30 Pareek G, Hedican S P, Gee J R, Bruskewitz R C, Nakada S Y. Meta-analysis of the complications of laparoscopic renal surgery: comparison of procedures and techniques.  J Urol. 2006 Apr;  175 (4) 1208-1213
• 31 Tacke J, Mahnken A H. [Percutaneous radiofrequency ablation of renal cell cancer].  Radiologe. 2004 Apr;  44 (4) 358-363
• 32 Vasudevan A, Davies R J, Shannon B A, Cohen R J. Incidental renal tumours: the frequency of benign lesions and the role of preoperative core biopsy.  BJU Int. 2006 May;  97 (5) 946-949
• 33 Chawla S N, Crispen P L, Hanlon A L, Greenberg R E, Chen D Y, Uzzo R G. The natural history of observed enhancing renal masses: meta-analysis and review of the world literature.  J Urol. 2006 Feb;  175 (2) 425-431
• 34 Cestari A, Guazzoni G, dell’Acqua V, Nava L, Cardone G, Balconi G. et al . Laparoscopic cryoablation of solid renal masses: intermediate term followup.  J Urol. 2004 Oct;  172 (4 Pt 1) 1267-1270
• 35 Gupta A, Allaf M E, Kavoussi L R, Jarrett T W, Chan D Y, Su L M. et al . Computerized tomography guided percutaneous renal cryoablation with the patient under conscious sedation: initial clinical experience.  J Urol. 2006 Feb;  175 (2) 447-452
• 36 Lawatsch E J, Langenstroer P, Byrd G F, See W A, Quiroz F A, Begun F P. Intermediate results of laparoscopic cryoablation in 59 patients at the Medical College of Wisconsin.  J Urol. 2006 Apr;  175 (4) 1225-1229
• 37 Shingleton W B, Farabaugh P, Hughson M, Sewell P. Effects of cryoablation on short-term development of urinary fistulas in the porcine kidney.  J Endourol. 2003 Feb;  17 (1) 37-40
• 38 Shingleton W B, Sewell Jr P E. Percutaneous renal cryoablation of renal tumors in patients with von Hippel-Lindau disease.  J Urol. 2002 Mar;  167 (3) 1268-1270
• 39 Gervais D A, Arellano R S, Mueller P R. Percutaneous radiofrequency ablation of renal cell carcinoma.  Eur Radiol. 2005 May;  15 (5) 960-967
• 40 Mayo-Smith W W, Dupuy D E, Parikh P M, Pezzullo J A, Cronan J J. Imaging-guided percutaneous radiofrequency ablation of solid renal masses: techniques and outcomes of 38 treatment sessions in 32 consecutive patients.  AJR Am J Roentgenol. 2003 Jun;  180 (6) 1503-1508
• 41 Su L M, Jarrett T W, Chan D Y, Kavoussi L R, Solomon S B. Percutaneous computed tomography-guided radiofrequency ablation of renal masses in high surgical risk patients: preliminary results.  Urology. 2003 Apr;  61 (4 Suppl 1) 26-33
• 42 Ahrar K, Matin S, Wood C G, Wallace M J, Gupta S, Madoff D C. et al . Percutaneous radiofrequency ablation of renal tumors: technique, complications, and outcomes.  J Vasc Interv Radiol. 2005 May;  16 (5) 679-688
• 43 Gervais D A, Arellano R S, Mueller P R. Percutaneous radiofrequency ablation of renal cell carcinoma.  Eur Radiol. 2005 May;  15 (5) 960-967
• 44 Mahnken A H, Gunther R W, Tacke J. Radiofrequency ablation of renal tumors.  Eur Radiol. 2004 Aug;  14 (8) 1449-1455
• 45 Gill I S, Remer E M, Hasan W A, Strzempkowski B, Spaliviero M, Steinberg A P. et al . Renal cryoablation: outcome at 3 years.  J Urol. 2005 Jun;  173 (6) 1903-1907
• 46 Shingleton W B, Sewell Jr P E. Percutaneous renal tumor cryoablation with magnetic resonance imaging guidance.  J Urol. 2001 Mar;  165 (3) 773-776
• 47 Shingleton W B, Sewell P E. Percutaneous cryoablation of renal cell carcinoma in a transplanted kidney.  BJU Int. 2002 Jul;  90 (1) 137-138
• 48 Shingleton W B, Sewell Jr P E. Cryoablation of renal tumours in patients with solitary kidneys.  BJU Int. 2003 Aug;  92 (3) 237-239
• 49 Gervais D A, Arellano R S, Mueller P R. Percutaneous radiofrequency ablation of renal cell carcinoma.  Eur Radiol. 2005 May;  15 (5) 960-967
• 50 Mayo-Smith W W, Dupuy D E, Parikh P M, Pezzullo J A, Cronan J J. Imaging-guided percutaneous radiofrequency ablation of solid renal masses: techniques and outcomes of 38 treatment sessions in 32 consecutive patients.  AJR Am J Roentgenol. 2003 Jun;  180 (6) 1503-1508
• 51 Su L M, Jarrett T W, Chan D Y, Kavoussi L R, Solomon S B. Percutaneous computed tomography-guided radiofrequency ablation of renal masses in high surgical risk patients: preliminary results.  Urology. 2003 Apr;  61 (4 Suppl 1) 26-33