Object

Title: Analysis of complications rate after nefron sparing surgery based on the Department of Urology material WSS L.Rydygiera in Krakow

Abstract:

Kidney cancer including RCC (Renal Cell Carcinoma) represent about 3% of all malignant tumors of adults. There are hereditary renal cancers and sporadic, and most of which are associated with chromosome aberrations. The treatment of choice for large tumors of the kidney is restricted to the RN (radical nephrectomy) and for tumors in stage T1 Nephron Sparing Surgery is recommended. Such treatments is assosiated with possibility of more complications, where the most frequent are bleedings, urinary fistulas, positive surgical margins, kidney failure and a need for haemodialyses. The working assumption is an analysis of complications after NSS, depending on morphological factors, clinical and demographic information. This study aims to assess the statistical complications and risk factors predisposing to their occurrence, assessment and of the oncology margins and improvement of the surgical technique. A retrospective study was conducted on a group of 195 patients with renal tumor who underwent NSS in the Department of Urology Rydygiera WSS in the period from 1997 to 2008. Complications were classified as an intraoperative, postoperative early and late. Statistical analysis was performed and results were considered statistically significant when were analyzed to a significance level of 0.05. Statistical analysis was performed using statistical package Statistica 9.0 PL. The Clavien complication scheme and its extensive scale in 7 positions allowed for the distribution of complications in the small (Clavien 1 and 2) and large (Clavien 3a, b 4a, b, 5) which requiring surgical intervention. Complication rate was 18%, and 5.64% of patients experienced more than one complication. The most common intraoperative bleeding was that in 5.6% of patients required blood transfusions. Urinary tract fistula occurred in 13.3% of patients, postoperative bleeding in 2% of the treated patients and 3 out of 4 resulted in nephrectomy. Renal failure with the necessity of hemodialysis and the positive margins occurred respectively in 2% and 3% of patients. Statistically significant factors predisposing to complications in the case of bleeding is: renal carcinoma and its progress in the scale of Fuhrman. Fistula occurred in elderly patients with hypertension, with a significantly longer WIT, a significantly longer duration of surgery, with an obstacle in the urine outflow and significantly more often in patients with single kidney. Isolated small complications, Clavien 1 and 2 occurred in 6.15% of the patients, and in further 4.61% of the patients necessitated surgical intervention Clavien 3 and 4. Major complications occurred in 13.3% of patients. 4b and 5 complications were not recorded. NSS is now considered the standard of care for the treatment of small renal tumours, with long-term oncologic results equivalent to that of radical nephrectomy and improvement in renal function.The risk factors identified in terms of complications, with proven efficacy of conservative proceedings against them and improved in terms of operative technique is the method of choice against tumors T1 and selected T2.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

nefrologia ; onkologia

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Lekarski.

Promoter:

Olgierd Smoleński

Date issued:

2011

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:3476

Call number:

ZB-117136

ControlNumberVIRTUA:

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Language:

pol

Access rights:

nieograniczony

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

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Last modified:

Feb 13, 2020

In our library since:

Mar 8, 2013

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Number of object content views in PDF format

1932

All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/3476

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ZB-117136 Feb 13, 2020
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