Functional results of organ preserving treatment of advanced renal cell cancer
Stakhovsky E.1, Vitruk I.1, Voylenko O.1, Stakhovskyi O.1, Kononenko O.1, Pikul M.1, Semko S.1, Hrechko B.1, Koshel D.1, Tumoshenko A.1, Buyvol O.1, Harbar R.2, Yatseniuk N.2
- 1Nonprofit Organization National Cancer Institute, Kyiv, Ukraine
- 2Urology Modern Center, Kyiv, Ukraine
Summary. The paper presents a comparative analysis of the functional results of treatment of 92 patients with locally advanced and metastatic RCC. The analysis of results was based on the assessment of separate renal function according to the data of dynamic nephroscintigraphy before renal resection or nephrectomy and 12 months after their performance. A statistically significant decrease in GFR was found after renal resection and nephrectomy, but GFR after nephrectomy was significantly lower than after resection (p <0.0001). The functions of the affected kidney by the tumor after its resection significantly decreased (maximum reduction of GFR by 74%) (p <0.006), which was associated with the volume of resection, the effect of the surgical injury on the kidney and central ischemia, but the function of the kidney was preserved. In some patients, GFR increased (maximum increase by 42%), which indicated a positive effect of tumor removal due to reduction of intrarenal pressure and restoration of nephron function. After nephrectomy, the GFR of the healthy kidney increased due to compensatory mechanisms (maximum increase of 65%), but there were patients in whom kidney function did not change reliably or even decreased (maximum decrease of 5%), which indicated the influence of other factors on the function of a single kidney. This factor was the presence of concomitant pathology, which significantly worsened the compensatory mechanisms of improving renal function. Thus, in the case of locally advanced and metastatic RCC, it is necessary to perform organ-sparing treatment, especially in patients with concomitant pathology, since this contingent of patients does not have compensatory possibilities for improving kidney function, which will lead to the occurrence of CKD and its consequences, as well as reduce the effectiveness of further treatment systemic therapy.
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