Can we consider temporary, preoperative active observation in patients with kidney tumors up to 3 cm in order to decrease the number of patients over-treated with NSS – nephron sparing surgery?

摘要

Introduction. The increasing number of benign andnon-cancerous tumors has resulted in the common useof NSS for the treatment of pT1 tumors. However, thiskind of treatment did not reduce the number of unnecessaryoperations.Material and methods. Two-hundred nineteen patientswith pT1 tumors treated with NSS were analyzed retrospectively.The mean time of observation was 77.9months. The patients were divided into groups dependingon tumor size and the degree of cellular differentiationof the tumor – DCTD (according to Fuhrman).Results. Statistical analysis revealed that an increasein tumor diameter accompanied a decrease in the percentageof patients with tumors staged pT1 as well asthose graded G1 and G0 (according to Fuhrmann). Meansurvival time also decreases. While the percentage oftumors graded G3, those staged pT3, unconventionalvarieties of renal cell carcinoma (RCC), local recurrence,as well as renal insufficiency all increase together withincreases in tumor diameter.Conclusions. In patients with tumors up to 3 cm, therisk of surgical overtreatment increases. In patientswith pT1 increases: the risk of unconventional varietiesof RCC, cancerous progression, and death along withthe increase in the size of the tumor and DCTD. Alongwith the size of pT1 tumors, a decrease in the numberof benign and non-cancerous tumors as well as5-years survival after NSS is observed. The dynamics ofcancerous changes in the tumors up to 2 cm is similarto the dynamics observed in the tumors up to 3 cm,whereas those of 4 cm act similarly as the tumors of 5cm diameter