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Laparoscopic cytoreductive nephrectomy as preparation for administration of systemic interleukin-2 in the treatment of metastatic renal cell carcinoma: a pilot study.

机译:腹腔镜细胞减灭性肾切除术作为全身性白介素2给药治疗转移性肾细胞癌的制剂:一项初步研究。

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OBJECTIVES: Cytoreductive nephrectomy is commonly performed in patients with metastatic renal cell carcinoma before systemic interleukin-2 (IL-2) therapy. Open nephrectomy is associated with prolonged recovery during which metastatic disease can progress. The feasibility of laparoscopic cytoreductive surgery in these patients with large renal tumors was examined. The role of tumor morcellation in reducing the recovery period and allowing earlier treatment with IL-2 was investigated. METHODS: Patients with metastatic renal cancer underwent either open nephrectomy (group 1, n = 19) or laparoscopic cytoreductive nephrectomy (n = 11; 6 with tumor morcellation [group 2], 5 with removal of the tumor through a small incision [group 3]). The three groups were compared to evaluate relative recovery, suitability for treatment with IL-2, and laparoscopic port site seeding. RESULTS: A group of 19 patients underwent open nephrectomy (group 1). Eleven patients with a median tumor volume of 377 cm3 (median tumor diameter 9 cm) underwent laparoscopic cytoreductive nephrectomy. Six of these patients underwent tumor morcellation (group 2) and 5 underwent laparoscopic assisted nephrectomy (group 3). There was no difference in patient age, sex, sites of metastatic disease, ECOG status, size of renal tumor, or surgical complication rates among groups. Patients whose tumor was morcellated had reduced postoperative parenteral narcotic requirements and were discharged sooner than patients undergoing open cytoreductive nephrectomy. Time to treatment with IL-2 was shortest in the morcellation group (median time to treatment 37 days). No port site seeding was observed. CONCLUSIONS: Laparoscopic cytoreductive nephrectomy in patients with bulky renal disease is a safe procedure in selected patients. This pilot study demonstrated a significant association of laparoscopic tumor morcellation with less postoperative pain, faster time to discharge, and shorter time to treatment with IL-2. A randomized study is warranted to determine the role of laparoscopic cytoreductive nephrectomy with tumor morcellation.
机译:目的:在系统性白介素-2(IL-2)治疗之前,转移性肾细胞癌患者通常需要进行细胞还原性肾切除术。开放性肾切除术与恢复期延长有关,在此期间转移性疾病可能会进展。在这些患有大肾脏肿瘤的患者中,检查了腹腔镜细胞减灭术的可行性。研究了肿瘤粉碎在缩短恢复期和允许早期用IL-2治疗中的作用。方法:转移性肾癌患者行开腹肾切除术(第1组,n = 19)或腹腔镜细胞减灭性肾切除术(n = 11; 6例行肿瘤切开术[2组],5例通过小切口切除肿瘤[3组] ])。比较这三组以评估相对恢复率,是否适合用IL-2进行治疗以及腹腔镜端口位点播种。结果:一组19例患者接受了开放性肾切除术(第1组)。 11名中位肿瘤体积为377 cm3(中位肿瘤直径为9 cm)的患者接受了腹腔镜细胞减灭性肾切除术。这些患者中有6例接受了肿瘤粉碎术(第2组),还有5例接受了腹腔镜辅助肾切除术(第3组)。各组之间的患者年龄,性别,转移性疾病部位,ECOG状态,肾肿瘤大小或手术并发症发生率无差异。肿瘤被粉碎的患者术后肠胃外麻醉药物的需求减少,并且比接受开腹细胞减少性肾切除术的患者更早出院。在粉碎组中,IL-2的治疗时间最短(中位治疗时间为37天)。没有观察到港口现场播种。结论:腹腔镜大细胞肾切除术肾切除术在某些患者中是安全的。这项初步研究表明,腹腔镜肿瘤粉碎术与术后疼痛减轻,出院时间加快和IL-2治疗时间缩短之间存在显着关联。有必要进行一项随机研究以确定腹腔镜细胞减灭性肾切除术与肿瘤粉碎的作用。

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