[Primary treatment of renal cell carcinoma. Yesterday, today, tomorrow].
Renal cancer accounts for 3% of all cancers; even in 2007 the diagnosis is often too late requiring a radical nephrectomy with an overall mediocre prognosis of 70% at 5 years. Nowadays, thanks to considerable improvement in imaging technique, 60% at least of tumors are early discovered on ultrasound examination; often of moderate size and less than 4 cms in diameter, which enables a more conservative approach to treatment. 740 radical nephrectomy were carried out in NECKER Hospital between 1985 and 2000; the results were similar to those in the literature; mediocre, with 85% survival at 5 years when the tumour was confined to the kidney (grades 1 and 2); 17% in the presence of lymph node involvment. Of the 722 conservative procedures carried out between 1987 and 2008, only 386 patients operated between 1987 and 2005 are being considered here. Although follow up is limited, the results are encouraging In Keeping with the literature, our results confirm the value of conservative surgery for early tumors with diameter of less than 4 cm. Low morbidity and disease free survival were similar to the data for radical nephrectomy With the aim of maximum renal conservation, newer mini invasive procedures such as cryoablation and radiofrequency destruction of tumors have been proposed. Our experience with radiofrequency destruction is described below for 167 tumors in 123 patients. Although the short-term outcome is satisfactory, it is difficult to judge the longer-term efficacy of these relatively rarely used newer techniques. While efforts are made to achieve early diagnosis thanks to modern imaging techniques and while conservative surgery appears to be the current strategy in the multidisciplinary management of tumours, there is still a large place for radical nephrectomy by open surgery or more often via video-assisted laparoscopic surgical techniques.
Dufour
Bertrand
B
Service d'Urologie à l'hôpital Necker Chirurgien de l'Hôpital Americain.
D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy