Die Nierenteilresektion beim Nierenzellkarzinom: Prinzipien und Kontroversen

Zusammenfassung

Die Teilresektion von Nierengewebe ist stets dann von Interesse, wenn der Erhalt und die Schonung renalen Parenchyms notwendig werden. Die erstmalige Partialresektion einer Niere wurde im Jahre 1884 von Wells durchgeführt, die erste Teilresektion aufgrund eines malignen Nierentumors wurde 1890 von Czerny beschrieben. In der Folge hat sich die Nierenteilresektion zu einer chirurgischen Standardmethode in der Behandlung des Nierenzellkarzinoms entwickelt und als effektive und zuverlässige Methode erwiesen. Ihre Bedeutung als therapeutische Option in der Kontrolle lokaler Nierentumoren ist vom richtigen Einsatz diagnostischer Methoden abhängig, da hierüber die korrekte Indikationsstellung und Patientenselektion erfolgt. Darüber hinaus müssen operative Kenntnisse und Fähigkeiten der chirurgischen Komplexität des Eingriffes gerecht werden, um postoperative Komplikationen zu vermeiden und das Auftreten von Tumorrezidiven zu kontrollieren. Die folgende Übersichtsarbeit führt die kontroversen Diskussionen und umfangreichen Studienergebnisse, sowie die grundlegenden Sachthemen zur Nierenteilresektion auf, durch die der aktuelle Stellenwert dieser operativen Methode gekennzeichnet ist.

Abstract

Whenever preservation of functioning renal parenchyma is important nephron-sparing surgery should be substituted for radical nephrectomy. The first partial nephrectomy was performed in 1884 by Wells for the removal of a perirenal fibrolipoma. Partial nephrectomy because of renal malignancy was first described in 1890 by Czerny. Today partial nephrectomy has become a standard procedure and provides effective therapy for appropriately selected patients with renal cell carcinoma. However, its future importance and value as a therapeutic option for the control of localized kidney tumor depends on the use of the correct diagnostic inventory to obtain an accurate indication and proper patient selection. Moreover, explicit attention has to be drawn to the surgical skills required to perform this complex operation and to prevent postoperative complications and control tumor recurrence.

Key words

Nephrectomy - Carcinoma - renal cell - kidney neoplasms - Follow-up studies - Surgery

Literatur

• 1 Wells S. Successful removal of to solid circum-renal tumors.  BMJ. 1884;  1 758
• 2 Czerny H E. Cited by Herczel E. Über Nierenextirpation.  Beitr Klin Chir. 1890;  6 485
• 3 Vermooten V. Indications for conservative surgery in certain renal tumors.  J Urol. 1950;  64 200-208
• 4 Novick A C. Indications and results of partial nephrectomy for renal cell carcinoma.  AUA Update Series. 1996;  Lesson 28, XV 222-226
• 5 Butler B P, Novick A C, Miller D P, Campell S A, Licht M R. Management of small unilateral renal cell carcinomas: radical versus nephron-sparing surgery.  Urology. 1995;  45 (1) 34-41
• 6 Lerner S E, Hawkins C A, Blute M L, Grabner A, Wollan P C, Eickholt J T, Zincke H. Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery.  J Urol. 1996;  155 1868-1873
• 7 Chernoff D M, Silverman S G, Kikinis R, Adams D F, Seltzer S E, Richie J P, Loughlin K R. Three-dimensional imaging and display of renal tumors using spiral CT: a potential aid to partial nephrectomy.  Urology. 43 (1) 125-129
• 8 Newhouse J H. The radiologic evaluation of the patient with renal cancer.  Urol Clin North Am. 1993;  20 (2) 231-246
• 9 Vordermark J S. Segmental anatomy of the kidney.  Urology. 1981;  17 (6) 521-531
• 10 Angermeier K W, Novick A C, Streem S B, Montie J E. Nephron-sparing surgery for renal cell carcinoma with venous envolvement.  J Urol. 1990;  144 1352-1355
• 11 Montie J E. Renal sparing surgery. In Droller MJ (ed). Surgical management of urologic disease. An anatomic approach St Louis: Mosby Year Book 1992: 378-393
• 12 Bernstein S M, Koyle M A, Gittes R F. Partial nephrectomy, extracorporeal surgery, and autotransplantation for renal cell carcinoma. In: Crawford ED, Das S (ed) Current genitourinary cancer surgery Philadelphia: Lea & Febiger 1990: 50-68
• 13 Novick A C, Streem S B. Surgery of the kidney. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ (ed) Campell's Urology, 7th edition Philadelphia: WB Saunders 1998: 2973-3061
• 14 Novick A C. Renal-sparing surgery for renal cell carcinoma.  Urol Clin North Am. 1993;  20 (2) 277-282
• 15 Motzer R J, Russo P, Nanus D M, Berg W J. Renal Cell Carcinoma.  Curr Probl Cancer. 1997;  21 (4) 185-232
• 16 Gilbert B R, Russo P, Zirinsky K, Kazam E, Fair W R, Vaughan E D. Intraoperative sonography: application in renal cell carcinoma.  J Urol. 1988;  139 582-584
• 17 Assimos D G, Boyce W H, Woodruff R D, Harrison L H, McCollough D L, Kroovand R L. Intraoperative renal sonography: a useful adjunct to partial nephrectomy.  J Urol. 1991;  146 1218-1226
• 18 Campell S C, Fichtner J, Novick A C, Steinbach F, Stoeckle M, Klein E A, Filipas D, Levin H S, Stoerkle S, Schweden S, Obuchowsky N A, Hale J. Intraoperative evaluation of renal cell cancer: a prospective study of the role of ultrasonography and histopathological frozen section.  J Urol. 1996;  155 1191-1195
• 19 Zincke H, Sen S E. Experience with extracorporeal surgery and autotransplantation for renal cell and transitional cell cancer of the kidney.  J Urol. 1988;  140 25-27
• 20 Calne R Y. Treatment of bilateral hypernephromas by nephrectomy, excision of tumor, and autotransplantation. Report of three cases.  Lancet. 1973;  2 1164-1167
• 21 Wickham J EA. Conservative renal surgery for adenocarcinoma: the place of bench surgery.  Brit J Urol. 1975;  47 25-36
• 22 Gittes R F, McCullough D L. Bench surgery for tumor in a solitary kidney.  J Urol. 1975;  113 12-15
• 23 Novick A C, Streem S B, Montie J E, Pontes J E, Siegel S, Montague D K, Goormastic M. Conservative surgery or renal cell carcinoma: a single-center experience with 100 patients.  J Urol. 1989;  141 835-839
• 24 Jacobs S C, Berg S I, Lawson R D. Synchronous bilateral renal cell carcinoma: Total surgical excision.  Cancer. 1980;  46 2341-2345
• 25 Topley M, Novick A C, Montie J E. Long-term results following partial nephrectomy for localized renal adenocarcinoma.  J Urol. 1984;  131 1050-1052
• 26 Zincke H, Swanson S K. Bilateral renal cell carcinoma: influence of synchronous and asynchronous occurrence on patient survial.  J Urol. 1982;  128 913-915
• 27 Clayman R V, Kavoussi L R, Soper N J, Dierks S M, Meretyk S, Darcy M D, Roemer F D, Pingleton E D, Thompson P G, Long S R. Laparoscopic nephrectomy: initial case report.  J Urol. 1991;  146 278-282
• 28 Clayman R V, Elbahnasy A, Elashry O, Hoenig D, Shalhav A, Figenshau R, McDougall E. Laparoscopic versus open radical/total nephrectomy for renal cell carcinoma.  J Urol. 1997;  157 328, (A1280)
• 29 Barrett P H, Fentie D D, Taranger L. Laparoscopic radical nephrectomy with morcellation.  J Endourol. 1997;  suppl, 11 S128, abstract P6-19
• 30 Janetschek G, Daffner P, Peschel R, Bartsch G. Laparoscopic nephron sparing surgery for small renal cell carcinoma.  J Urol. 1998;  159 1152-1155
• 31 Campell S C, Novick A C, Streem S B, Klein E, Licht M. Complications of nephron sparing surgery for renal tumors.  J Urol. 1994;  151 1177-1180
• 32 Polascik T J, Pound C R, Meng M V, Partin A W, Marshall F F. Partial nephrectomy: technique, complications, and pathological findings.  J Urol. 1995;  154 1312-1318
• 33 Marberger M, Pugh R CB, Auvert J, Bertermann H, Costantini A, Gammelgaard P A, Petterson S, Wickham J EA. Conservative surgery of renal carcinoma: the EIRSS experience.  Br J Urol. 1981;  53 528-532
• 34 Carini M, Selli C, Barbanti G, Lapini A, Turini D, Costantini A. Conservative surgical treatment of renal cell carcinoma: clinical experience and reappraisal of indications.  J Urol. 1988;  140 725-731
• 35 Petritsch P H, Rauchenwald M, Zechner O, Ludvik W, Pummer K, Urlesberger H, Eberle J, Joos H, Kaufman F, Kugler W, Decristoforo A, Dittel E E. Results after organ-preserving surgery for renal cell carcinoma. An austrian multicenter study.  Eur Urol. 1990;  18 84-87
• 36 Morgan W, Zincke H. Progression and survival after renal-conserving surgery for renal cell carcinoma: experience in 104 patients and extended followup.  J Urol. 1990;  144 852-858
• 37 Provet J, Tessler A, Brown J, Golimbu M, Bosniak M, Morales P. Partial nephrectomy for renal cell carcinoma: indications, results and implications.  J Urol. 1991;  145 472-476
• 38 Van Poppel H, Claes H, Willemen P, Oyen R, Baert L. Is there a place for conservative surgery in the treatment or renal carcinoma.  Br J Urol. 1991;  67 129-133
• 39 Steinbach F, Stoeckle M, Mueller S C, Thueroff J W, Melchior S W, Stein R, Hohenfellner R. Conservative surgery of renal cell tumors in 140 patients: 21 years of experience.  J Urol. 1992;  148 24-30
• 40 Moll V, Becht E, Ziegler M. Kidney preserving surgery in renal cell tumors: indications, techniques and results in 152 patients.  J Urol. 1993;  150 319-323
• 41 Trasher J B, Robertson J E, Paulson D F. Expanding indications for conservative renal surgery in renal cell carcinoma.  Urology. 1994;  43(2) 160-168
• 42 Licht M, Novick A C, Goormastic M. Nephron sparing surgery in incidental versus suspected renal cell carcinoma.  J Urol. 1994;  152 39-42
• 43 Novick A C, Straffon R A. Management of locally recurrent renal cell carcinoma after partial nephrectomy.  J Urol. 1987;  138 607-610
• 44 Zincke H, Ghavamian R. Partial nephrectomy for renal cell cancer is here to stay - more data on this issue (editorial).  J Urol. 1998;  159 1161-1162
• 45 Kletscher B A, Qian J, Bostwick D G, Andrews P E, Zincke H. Prospective analysis of multifocality in renal cell carcinoma: influence of histological pattern, grade, number, size volume and desoxyribonucleic acid ploidy.  J Urol. 1995;  153 904-906
• 46 Kletscher B A, Qian J, Blute M L, Zincke H, Thibodeau S, Bostwick D G. Clonal origin or renal cell carcinoma.  J Urol. 1996;  155 A542
• 47 Gohji K, Hara I, Gotoh A, Eto H, Miyake H, Okada H, Arakawa S, Kamidono S. Multifocal renal cell carcinoma in japanese patients with tumors maximal diameters of 50 mm or less.  J Urol. 1998;  159 1144-1147
• 48 Foster M H, Sant G R, Donohoe J F, Harrington J T. Prolonged survival with a remnant kidney.  Amer J Kidney Dis. 1991;  17 (3) 261-265
• 49 Solomon L R, Mallick N P, Lawler W. Progressive renal failure in a remnant kidney.  Brit Med J. 1985;  291 1610-1611
• 50 Novick A C, Gephardt G, Guz B, Steinmuller D, Tubbs R R. Long-term follow-up after partial removal of a solitary kidney.  New Engl J Med. 1991;  325 1058-1062
• 51 Brenner B M. Hemodynamically mediated glomerular injury and the progressive nature of kidney disease.  Kidney Int. 1983;  23 (4) 647-655
• 52 Meyer T W, Anderson S, Rennke H G, Brenner B M. Converting enzyme inhibitor therapy limits progressive glomerular injury in rats with renal insufficiency.  Am J Med. 1985;  79 (suppl 3C) 31-36
• 53 Dayal H H, Wilkinson G S. Epidemiology of renal cell cancer.  Sem Urol. 1989;  7 139-143
• 54 Silverberg E, Lubera J A. Cancer statistics.  CA Cancer J Clin. 1989;  39 3-23
• 55 Penn I. Renal transplantation in patients with pre-existing malignancies.  Transplant Proc. 1983;  15 1079-1082
• 56 Eggers P W. Mortality rates among dialysis patients in Medicare's end-stage renal disease program.  Am J Kidney Dis. 1990;  XV 414-421
• 57 Rosenthal J T, Danovitch G, Ettenger R B, Wilkinson A. Kidney transplantation at UCLA. In: Terasaki PI (ed): Clinical Transplants 1990 Los Angeles: UCLA Tissue Typing Laboratory 1990: 255-263
• 58 Melmon K L, Rosen S W. Lindau's disease. Review of literature and study of a large kindred.  Am J Med. 36 595-617
• 59 Maher E R, Yates J R, Harries R, Benjamin C, Harris R, Moore A T, Ferguson-Smith M A. Clinical features and natural history of von Hippel-Lindau disease.  Quart J Med. 1990;  77 (238) 1151-1163
• 60 Glenn G, Choyke P, Zbar B, Linehan W M. Von Hippel-Lindau disease: clinical review and molecular genetics.  Prob Urol. 1990;  4 312-330
• 61 Poston C D, Jaffe G S, Lubensky I A, Solomon D, Zbar B, Lineham W M, Walther M M. Characterization of the renal pathology of a familial form of renal cell carcinoma associated with von Hippel-Lindau disease: clinical and molecular genetic implications.  J Urol. 1995;  153 22-26
• 62 Richards A D, Mebust W K, Schimke R N. A prospective study in von Hippel-Lindau disease.  J Urol. 1973;  110 27-30
• 63 Loughlin K R, Gittes R F. Urological management of patients with von Hippel-Lindau disease.  J Urol. 1986;  136 789-791
• 64 Horton W A, Wong V, Eldrige R. Von Hippel-Lindau disease: clinical and pathological manifestations in nine families with 50 affected members.  Arch Intern Med. 1976;  136 769-777
• 65 Solomon D, Schwartz A. Renal pathology in von Hippel-Lindau disease.  Hum Path. 1988;  19 1072-1079
• 66 Christenson P J, Craig P J, Bibro M C, O'Connell K J. Cysts containing renal cell carcinom in von Hippel-Lindau's disease.  J Urol. 1982;  128 798-800
• 67 Taylor R J. Case for nephron-sparing surgery in managing renal cell carcinoma.  Sem Urol. 1993;  XI (2) 104-111
• 68 Novick A C, Streem S B. Long-term follow-up after nephron sparing surgery for renal cell carcinoma in von Hippel-Lindau disease.  J Urol. 1992;  147 1488-1490
• 69 Walther M M, Choyke P L, Weiss G, Manolatos C, Long J, Reiter R, Alexander R B, Linehan W M. Parenchymal sparing surgery in patients with hereditary renal cell carinoma.  J Urol. 1995;  153 913-916
• 70 Steinbach F, Novick A C, Zincke H, Miller D P, Williams R D, Skinner D G, Esrig D, Richie J P, DeKernion J, Marshall F, Marsh C L. Treatment of renal cell carcinoma in von Hippel-Lindau disease: a multicenter study.  J Urol. 1995;  153 1812-1816
• 71 Persad R A, Probert J L, Sharma S D, Haq A, Doyle P T. Surgical management of the renal manifestation of von Hippel-Lindau disease: a review of a United Kingdom case series.  Br J Urol. 1997;  80 392-396
• 72 Frydenberg M, Malek R D, Zincke H. Conservative renal surgery for renal cell carcinoma in von Hippel-Lindau's disease.  J Urol. 1993;  149 461-464
• 73 Bazeed M A, Schaerfe T, Becht E, Jurincic C, Alken P, Thueroff J W. Conservativ surgery for renal cell carcinoma.  Eur Urol. 1986;  12 238-243
• 74 Naitoh J, Belldegrun A S. Interferon and kidney cancer: a promise unfulfilled.  Can J Sci Am. 1998;  4 (3) 155-156
• 75 Figlin R, Gitlitz B, Franklin J, Moldawer N, Rausch J, DeKernion J, Belldegrun A S. Interleukin-2-based immunotherapy for the treatment of metastatic renal cell carcinoma: an analysis of 203 consecutively treated patients.  Can J Sci Am. 1997;  3, suppl 1 S92-97
• 76 Wunderlich H, Reichelt O, Schumann S, Schlichter A, Kosmehl H, Werner W, Vollandt R, Schubert J. Nephron sparing surgery for renal cell carcinoma 4 cm or less in diameter: indicated or undertreated.  J Urol. 1998;  159 1465-1469
• 77 Curry N, Schabel I, Besill W. Small renal neoplasms: diagnostic imaging, pathologic features, and clinical course.  Radiology. 1986;  158 113-117
• 78 Aso Y, Homma Y. A survey of incidental renal cell carcinoma in Japan.  J Urol. 1992;  147 340-343
• 79 Konnak J W, Grossmann H B. Renal cell carcinoma as an incidental finding.  J Urol. 1985;  134 1094-1096
• 80 Smith S J, Bosniak M A, Megibow A J, Hulnik D H, Horii S C, Raghavendra B N. Renal cell carcinoma: earlier discovery and increased detection.  Radiology. 1989;  170 699-703
• 81 Tsukamoto T, Kumamoto Y, Yamazaki K, Miyao N, Takahashi A, Masumori N, Satoh M. Clinical analysis of incidentally found renal cell carcinoma.  Eur Urol. 1991;  19 109-113
• 82 Steinbach F, Stoeckle M, Riedmiller H, Weingaertner K, Hohenfellner R. Tumor enucleation of renal cell carcinoma: operative technique, DNA cytometry, results, complications.  Prog Clin Biol Res. 1991;  370 1-7
• 83 Frank W, Guinan P, Stuhldreher D, Saffrin R, Ray P, Rubenstein M. Renal cell carcinoma: the size variable.  J Sur Onc. 1993;  54 163-166
• 84 Brisset J M, Lugagne P M, Veillon B, Vallancien G, Charton M, Bougaran A. Parenchymal-sparing surgery for small renal cell cancer: are there any reasonable arguments.  Prog Clin Biol Res. 1989;  303 153-159
• 85 Selli C, Lapini A, Carini M. Conservative surgery of kidney tumors.  Prog Clin Biol Res. 1991;  370 9-17
• 86 Licht M, Novick A C. Nephron sparing surgery for renal cell carcinoma.  J Urol. 1993;  149 1-7
• 87 Krumbach R W, Ansell J S. Partial resection of the right kidney and radical removal of the left kidney in a patient with bilateral hypernephroma.  Surg. 1959;  43 585-592