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Oral Presentation - 111
NEPHRON SPARING SURGERY FOR UNI- AND BILATERAL RENAL TUMOURS – THE COMPLICATION RISK.
Jan Godzinski 1, Joerg Fuchs 2, Max Pachl 3, Sabine Irtan 4, C.P.(Kees) Vanm de Ven 5, Amos Loh 6, Maria L Apezzato 7, Gordan Vujanic 8, Malgorzata Rapala 1, Harm van Tinteren 5, Bernarda Kazanowska 9, Marry van den Huevel-Eibrink 5, Norbert Graf 10
1 Dept. of Paediatric Surgery, Marciniak Hospital, Wroclaw, Poland
2 Dept. of Paediatric Surgery and Urology, University of Tuebingen, Germany
3 Birmingham Women's and Children's NHS Foundation Trust, United Kingdom
4 University of Paris, Hospital Armand Trousseau, FRance
5 Prinses Maxima Centrum, Utrecht, The Netherlands
6 KK Women's and Chilkdren's Hospital, Singapore (KKH)
7 Cirurgia Pediatrica - A.C. Camargo Cancer Center, Sao Paolo, Brasil
8 Dept. of Pathology, Sidra Medicine and Will Cornell Medicine, Qatar, Doha, Qatar
9 Clinical Dept. of Bone Marrow Transplantation, Oncology and Haematology, Medical University, Wroclaw, Poland
10 Dept. of Paediatric Oncology and Haematology, University of Saarland, Homburg, Germany
Background: The nephron sparing resection (NSS) of renal tumors (RT) is crucial in patients (pts) with bilateral RT to avoid dialysis and renal transplantation. The NSS in pts with unilateral RT, if appropriately selected for NSS, may assure the same oncological outcome as total nephrectomy and significantly improve their quality of life in these potential long-term survivors. The risk of surgical complications may significantly influence the therapeutic decision in each of the above groups.
Aim of this study is to evaluate the rate of NSS-related complication and its potential influence on the further outcome in pts with bilateral and unilateral RT.
Methods: Of 7738 pts registered in the SIOP2001, 4285 were unilateral localised, 829 – unilateral metastatic, 203 bilateral non-metastatic and 43 were bilateral and metastatic. The age of patients remained in the pre-school group, sex distribution of the patients was nearly equal. The intermediate risk pathology was the most frequent in analysed pts. The other variants were not dominating in any group, however the high risk variant was more frequent in bilateral non-metastatic RT (17% of those cases), whereas the low risk in bilateral metastatic cases (13%).
Results: Among unilateral cases +/- distant metastases - 2.4 % underwent NSS, among bilateral non-metastatic RT – 20% underwent bilateral NSS and 25% NSS and total nephrectomy (TN), among bilateral/metastatic pts – 7.7% underwent bilateral NSS, 35% NSS and TN. Complications by quality of surgery: following complete NSS, the complications occurred in 4.3% comparing to 14% in case of incomplete NSS. Minor tumour rupture, bleeding and intussusception and so called “other” were noted as complications.
Conclusion: In case of clear feasibility of complete NSS, complications in either unilateral or bilateral pt are rare and its risk should not influence the treatment decisions.