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description Journal article public ScienceRise: Medical Science

Results of Nephron-sparing Surgery for Multifocal Kidney Tumors

Gennadii Khareba, Volodymyr Lisoviy, Dmytro Shchukin
Published 2020

Abstract

Surgical treatment is the main therapy for patients with renal cell carcinoma. The current trend in the treatment of kidney tumours is the widespread introduction of nephron-sparing surgery. This tendency is applied to complex types of large size tumours, with venous tumour thrombus, intrarenal, and multifocal kidney tumours. The aim: to investigate the results of nephron-sparing surgery for multifocal kidney tumours.Material and methods. The results were obtained after nephron-sparing surgery of 701 patients with renal tumours. After the distribution of all patients according to the criterion of "multifocality", the study dealt with assessment of 22 (3.1 %) cases of nephron-sparing surgery. There were also 679 (96.9 %) patients with a solitary tumour.Results. It was found that the multifocality of renal tumours is a significant factor in the complexity of nephron-sparing surgery. It was demonstrated by increase in the time of surgery, more blood loss and a longer time of kidney ischemia, and kidney function was worse than after operations with solitary tumours. Follow-up during 46.5±2.1 months on average was performed. A significant difference (p<0.026) was found only in the number of patients with distant metastases. These patients had mostly multifocal tumours.The results of the comparative statistical analysis showed that the 5-year overall survival among patients with multifocal tumours was 88.9 % and among patients with solitary tumours it was 94.6 %. The differences were not significant (p>0.937). At the same time, the 5-year overall progression-free survival was better for patients with solitary tumours (p<0.041).Conclusion. The multifocality of renal tumours is a significant factor in the complexity of nephron-sparing surgery, which is reflected in the surgical results of treatment.The results showed that the nephron-sparing surgery of multifocal neoplasms of the kidney does not demonstrate a significant increase in the frequency of local recurrence. However, 5-year progression-free survival among patients with multifocal tumours was worse and distant metastases were diagnosed more often than among patients with solitary tumours

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