Ebook The management of small renal masses: Part 2
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Ebook The management of small renal masses: Part 2
Open Partial Nephrectomy8M. Hammad AtherAbbreviationsBHDBirt-Hogg-Dubé syndromeHRPCHereditary papillary renal carcinomaNSSNephron-sparing surgeryOPNOp Ebook The management of small renal masses: Part 2pen partial nephrectomyOSOverall survivalPFSProgression-free survivalPNPartial nephrectomyRNRadical nephrectomySRMSmall renal massVHLVon Hippel-LindauKey Messages•The three main goals of open partial nephrectomy (OPN) are complete removal of tumour, preservation of renal function and minimal periope Ebook The management of small renal masses: Part 2rative complications.•Standardization of the surgical technique of open partial nephrectomy along with excellent oncological outcomes and reduced morbEbook The management of small renal masses: Part 2
idity has contributed to its growing application around the world.•Preoperative and multidisciplinary care with nephrologist helps optimize renal funcOpen Partial Nephrectomy8M. Hammad AtherAbbreviationsBHDBirt-Hogg-Dubé syndromeHRPCHereditary papillary renal carcinomaNSSNephron-sparing surgeryOPNOp Ebook The management of small renal masses: Part 2OPN usually employs a flank, thoracoabdominal or subcostal incision, but a dorsal lumbotomy may also be used.M. Hammad AlherAga Khan University. Karachi. Pakistane-mail: hammad.atherW'aku.cdu8.1IntroductionOver the last three decades, renal cell cancer is increasingly being diagnosed at a much earli Ebook The management of small renal masses: Part 2er stage than in the past [ I J. This owes primarily to the widespread use of ultrasound and CT. Technological improvements in imaging(0 Springer InteEbook The management of small renal masses: Part 2
rnational Publishing AG 2018K. Ahmed el al. (cds.). The Management of Small Renal Masses.https://doi.org/10.1OO7/97X-3-319-65657-1_88788M. Hammad AtheOpen Partial Nephrectomy8M. Hammad AtherAbbreviationsBHDBirt-Hogg-Dubé syndromeHRPCHereditary papillary renal carcinomaNSSNephron-sparing surgeryOPNOp Ebook The management of small renal masses: Part 2e largest dimension on imaging |2|. It has been estimated that at least 48-66% of RCC diagnoses occur as a result of cross-sectional imaging in otherwise asymptomatic patients [3|. Tla RCC has become an increasingly prevalent clinical scenario for urologic surgeons, and it has become imperative to u Ebook The management of small renal masses: Part 2se less invasive means of management for these masses. Nephron-sparing approaches. particularly partial nephrectomy (PN). have become increasingly popEbook The management of small renal masses: Part 2
ular. Although it can be performed laparoscopically and by robot-assisted PN. the greatest experience remains in open partial nephrectomy.In the initiOpen Partial Nephrectomy8M. Hammad AtherAbbreviationsBHDBirt-Hogg-Dubé syndromeHRPCHereditary papillary renal carcinomaNSSNephron-sparing surgeryOPNOp Ebook The management of small renal masses: Part 2g kidney disease |4|. However, lately it is being employed at tertiary-care centres for the management of localized renal tumours. Nephron-Sparing surgery (NSS) is also valuable in cases of unilateral multifocal RCC and bilateral renal tumours. They are typically seen in various hereditary forms of Ebook The management of small renal masses: Part 2RCC. like Von Hippel-Lindau (VHL). hereditary papillary renal carcinoma (HRPC) and Birt-Hogg-Dubé (BHD) syndromes. Bilateral and multifocal renal cancEbook The management of small renal masses: Part 2
ers are challenging clinical scenarios. Management strategies include concomitant bilateral PN and staged PN with either the more complex side done fiOpen Partial Nephrectomy8M. Hammad AtherAbbreviationsBHDBirt-Hogg-Dubé syndromeHRPCHereditary papillary renal carcinomaNSSNephron-sparing surgeryOPNOp Ebook The management of small renal masses: Part 2 however, several series report on the successful use of PN for tumours larger than 7 cm or with renal vein thrombus (5). Alanee et al. reviewed contemporary series on data of 359 patients undergoing PN for T2+ RCC |6|. Median tumour size was 7.5-8.7 cm. and tumour histology was mainly clear cell. T Ebook The management of small renal masses: Part 2echnique was mainly open, the reported median ischaemia time was 29-45 min. and median operative time was 170-221 min. Positive margin rates were 0-31Ebook The management of small renal masses: Part 2
%. With a median follow-up ofbetween 13 and 70 months, a 5-year progression-free survival (PFS) was 71-92.5%. and a 5-year overall survival (OS) was 6Open Partial Nephrectomy8M. Hammad AtherAbbreviationsBHDBirt-Hogg-Dubé syndromeHRPCHereditary papillary renal carcinomaNSSNephron-sparing surgeryOPNOp Ebook The management of small renal masses: Part 2. Radical nephrectomy (RN) however continued to be standard surgical approach for most renal tumours outside specialized centres. This was partly due IO associated complications and concern for oncological outcomes. Most commonly encountered complications are haemorrhage, urinary fistula formation, Ebook The management of small renal masses: Part 2ureteral obstruction, acute renal insufficiency and infection |8|. Van Poppel el al. compared PN (/» = 2 68) and RN (/» = 273) together with a limitedEbook The management of small renal masses: Part 2
lymph node dissection in a prospective, multicentre, phase 3 trial [9|. It was noted that PN for small, easily resectable, incidentally discovered RCOpen Partial Nephrectomy8M. Hammad AtherAbbreviationsBHDBirt-Hogg-Dubé syndromeHRPCHereditary papillary renal carcinomaNSSNephron-sparing surgeryOPNOp Ebook The management of small renal masses: Part 2 data for oncological outcomes showed 10-year OS rates of 81.1% for RN and 75.7% for PN. With a hazard ratio (HR) of 1.50 (95% confidence interval [CI |. 1.03-2.16). the test for non-inferiority is not significant (/> = 0.77). and the test for superiority is significant (/> = 0.03) 110]. There is co Ebook The management of small renal masses: Part 2nsiderable evidence that PN reduces the risk of chronic kidney disease (CKD) compared with RN |7|. When compared with RN. PN always provides better reEbook The management of small renal masses: Part 2
nal functional outcomes in similar patients (11Ị.Objectives of Open Partial Nephrectomy The three main goals of OPN are:1Complete removal of tumourOpen Partial Nephrectomy8M. Hammad AtherAbbreviationsBHDBirt-Hogg-Dubé syndromeHRPCHereditary papillary renal carcinomaNSSNephron-sparing surgeryOPNOpOpen Partial Nephrectomy8M. Hammad AtherAbbreviationsBHDBirt-Hogg-Dubé syndromeHRPCHereditary papillary renal carcinomaNSSNephron-sparing surgeryOPNOpGọi ngay
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