role of surgery in rcc note

7/26/2019 Role of Surgery in Rcc Note

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ROLE OF SURGERY inRCC


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Inspite of our understanding about RCC, surgeryremains the major for urati!e treatment of thisdisease, "ith the objeti!e of surgia# theraphy iremo!e a## tumor "ith ade$uate surgia# marginUnfortunate#y, our abi#ity to sa#!age patients "itad!aned disease remains #imited% The primarythat limits the widespread implementationearly screening for RCC is the relatively low


3/11

& journa# by Laurent 'ini and o##eagues sho"edpopu#ation based omparison of sur!i!a# afternephretomy !ersus non surgia# treatment in (sur!ei##ane% Re#ati!e to nephretomy, *S+ appeundermine the o!era## and anerspei- sur!i!patients "ith sma## rena# masses by as muh as at 1 years% So nephretomy shou#d be onsiderestandard of are in young and hea#thy patients


4/11

Thats why, Robson and colleagues in 1969RN as gold standard in curative intent for R!everal studies demonstrate "#year survivaof $%& to 9%& for organ#con'ned disease adocument a 1"& to (%& reduction in survivassociated with invasion of the perinephric23onta4 and Campbe##, 56678 Leibo!ih et a#, 56Lane and 3attan, 5669:%

;he perepti!e about rena# masses ha!e hangedeades%


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Nephron#sparing surgery has beame importurati!e intent at #oa#ied tumor espeia##y inimperati!e indiation suh as bi#atera# tumors, tuso#itary 4idney, or patient at high ris4 of future rfai#ure, beause afunctioning renal remnantleast (%& of one )idney is necessary to avoend#stage renal failure, although this presugood functional status of the remainingparenchyma *ocal recurrence after +N forimperative indications has ranged from &hinges to hi#ar tumor #oation, the need to min

the amount of e?ised funtiona# parenhyma, tmu#tifoa#it or other om #e?ities U>>o and *o


6/11

-any resources have shown almost e.uallye/ective curative treatment between radicnephron sparing surgery in locali0ed RCCpro!ed in journa#s by Campbe## an o##egues thalocal recurrence in the remnant )idney aftefor RCC has been reported in 1& to 1%& patients, and the main ris) factor is advancstage 2Campbe## and *o!i4, (../8 Lane and G3rambe4 et a#, 5669:% *ocal recurrence of RCradical nephrectomy is occurring in (& to


7/11

&nother journa# by Laurent 'ini sho"ed sur!i!a# bet"een patients treated partia# dan radia#nephretomy ha!e sma## diAerene% ;hat the surate diAerenes of partia# !ersus radia# "as 7%/


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Cytoreductive NephrectomyD is it aoption in patients "ith rena# aner

Curati!e surgery a#most impossib#e in disseminated dise

ma4e the ro#e of surgery in a patient "ith metastases hdisputed

FOR &G&I*S;

;reatment=pre!ention of tumouromp#iation 2haematuria,

b#eeding,an4 pain:

;reatment a#ternati!es a!a2embo#i>ation=irradiatio

Spontaneous regression ofmetastases

Use#ess 2"ast of time

Remo!e soure of ne" metastasesangerous 2perioperat

morbidity=morta#ity:

Redution of tumour burden *o sur!i!a# bene-t e!er on

Remo!e trap for traH4ing

#ymphoytes +ay ompromise immune s


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2nterferon alfa -onotherapy or 2nterfealfa with Cytoreductive Nephrectomy4-etastatic Renal Cell Carcinoma

role of surgery in rcc note

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