H. Van Poppel - Kidney cancer - Surgery (including nephron-sparing surgery)
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H. Van Poppel - Kidney cancer - Surgery (including nephron-sparing surgery)
- 1. RCC: Surgery Hein Van Poppel UZ Gasthuisberg Leuven, Belgium Lugano 2011 ECCLU 2011 is held under the auspices of the European School of Urology
- 3. 1963 Increasing Incidence of Small RCC Events per 100,000U.S. population HOLLINGSWORTH, JCI 98:1333, 2006 < 2cm 2-4cm 4-7cm > 7cm 1985 1987 1989 1991 2001 1993 1995 1997 1999 n=34.503
- 4. Mortality for RCC and all causes Up to 5 y. after surgical therapy Hollingsworth et al. Cancer 2007 Survival non RCC mortality RCC mortality .
- 6. WHAT ABOUT RADICAL NEPHRECTOMY ?
- 8. Extended LND for RCC R L Crispen et al., Eur.Urol.,2011 8
- 12. Reassessing the Lymph Node Staging for RCC Dimashkieh HH et al. J Urol 2006; 176: 1978-1983 ENE =Extranodal extension 12
- 13. Tumour, Nodes, Metastases Staging System Nx Regional Lymphnodes Idem cannot be assessed N0 Regional lymphnodes Idem negative N1 Metastasis to a 4 or less positive nodes single node (no extranodal invasion) N2 Metastasis in > > 4 positive nodes 1 Lymph node (extranodal invasion) TNM, 2002 TNM, ?? V.Ficarra 13
- 14. What to do in cN+ patients ? Radical Nephrectomy and Robson-LND 14
- 15. Rad.Nx Part.Nx Tachosil 15
- 18. Performance of Adrenalectomies 1989 to 2004 P.Russo et al., Cancer, 2008 RCC patients Adrenalectomy No Yes
- 19. RCC Incidence RCC Mortality Lipworth et al. J Urol 176:2353, 2006 19
- 20. 20
- 21. 21
- 22. WHAT ABOUT PARTIAL NEPHRECTOMY ?
- 23. P.Russo et al., Cancer, 2008 Numbers of Radical or Partial Nephrectomies
- 25. Elective Nephron-sparing Surgery for Localized RCC Valdez-Mendoza, 2008 N° pts 5-y DFS (% ) Local recurr. (% ) Median FU (mos) Van Poppel et al . (1998) [44] 51 98 0 75 Herr (1999) [9] 70 97 1.5 120 Hafez et al . (1999) [10] 45 100 0 35 Lee et al . (2000) [4] 37 100 0 40 Lau (2000) [23] 189 98 1 44 Filipas et al . (2000) [49] 180 98 1.6 56.4 McKiernan et al . (2002) [22] 117 100 1.2 25 Kural et al . (2003) [51] 50 100 0 33.1 Patard et al . (2004) [11] 379 97.8 0.8 51
- 26. Overall Survival Cure rates of Partial and Radical Nx for small RCC are similar Eur.Urol. 2011 26
- 28. Partial Nephrectomy for Small Renal Masses D.C. Miller, 2006. SEER Data Part. Nx in 9.6% of cases of RCC (1988-2001) % 4 28
- 30. 30
- 31. Enucleation Enucleoresection NSS 31
- 33. 33
- 34. Wedge resection Polar Nephrectomy NSS 34
- 37. 37
- 38. WHAT ABOUT THE MARGINS ? 38
- 39. Intact PseudoCapsule in most RCC’s 39
- 40. 1 cm RCC Pseudocapsule?? 40
- 41. PseudoCapsular Perforation No PseudoCapsule 41
- 42. Multifocality as reason for recurrence 42
- 47. WHAT ABOUT LARGER TUMORS ? 47
- 48. OPEN PARTIAL NEPHRECTOMY SURVIVAL vs. TUMOR DIAMETER 0 12 24 36 48 60 72 84 96 108 120 < 4 cm 310 PATS. > 4 cm 175 PATS. Months Ca. specific survival % HAFEZ, J.UROL. 162:1930, 1999 48 0 20 40 60 80 100
- 49. T1b Midpole Wedge to Enucleation 49
- 52. T1b - T3a Upper Pole 52
- 54. WHAT ABOUT CENTRAL TUMORS ? 54
- 55. Centrally located tumors NSS ? Rad.Nx 55
- 57. Planning intra-renal tumor 57
- 58. Hilar (A-V) Clamping Surface Cooling 58
- 59. T1a Intrarenal Enucleation 59
- 60. WHAT ABOUT MULTIFOCAL TUMORS ? 60
- 61. And Multifocal RCC ? 60
- 62. 61
- 64. Partial Nephrectomy (Cleveland Clinic) 0 50 100 150 200 250 1995 1996 1997 1998 2000 2001 2002 2003 2004 Open Laparoscopic I . GILL, AAGUS, 2006 63
- 67. C L AMP ING ECHO 66
- 68. Hemostasis 67
- 70. Management of Renal Tumors (JOHNS HOPKINS) 1998 2000 2001 1999 1997 2005 0 40 60 80 100 20 ORN OPN LRN LPN LRA PRA % PEMPONGKOSOL, BJUInt 98:751, 2006 2002 2003 2004 1996 1995 1994 1993 1992 1991 1621 PATIENTS Open Radical Lap.Radical Open Partial Lap.Partial RFA WW ? 69
- 71. WHAT ABOUT ABLATIVE THERAPIES ? 70
- 75. RFA 74
- 77. PERCUTANEOUS CRYO J. RICHIE, BRIGHAM, BOSTON 76
- 78. HIFU 20-40 W/cm 2 1600-2000 W/cm 2 DEPT. UROLOGY, UNIVERSITY OF VIENNA Still experimental 77
- 81. Renal Cancer Treatment Kim, J Urol ‘03 McDougall, J Urol ‘96 Corman, Br J Urol ‘00 Lotan, Br J Urol ‘05 Kercher, Surg End ‘03 80 Rad Nx Open Part.Nx Lap Part.Nx Ablation Morbidity 15% 16% 20% 2-6% Recovery 35 days 33 days 12 days 1 day Mortality 2% 1.6% <1% <0.5% Hospital Stay 5 days 3 days 1.9 days 0.5-1 day Cost $31,000-35,000 $26,000-32,000 $26,000-32,000 $5,000-10,000
Editor's Notes
- SRMs: small renal masses NSS: nephron-sparing surgery
- In conclusions,
- In conclusions,
- In conclusions,
- Moving to locally advanced RCC, As you know, they are classified as pT3 and pT4. The former group includes tumours invading perirenal fat and/or ipsilateral adrenal gland, T3a, as well as those presenting with thrombosis within the renal vein or the vena cava below or above the diaphragm. Moreover, T4 RCC were characterized by tumours extending beyond the gerota fascia.
- LPN: laparoscopic partial nephrectomy OPN: open partial nephrectomy
- RFA: radiofrequency ablation MINS: minimally invasive nephron-sparing AS: active surveillance
- RFA: radiofrequency ablation HIFU:High Intensity Focused Ultrasound MWT: Microwave Thermotherapy LITT: Laser Interstitial Thermal Therapy PCU: Pulsed Cavitational Ultrasound