Radical nephrectomy for large renal tumors: evaluate perioperative and oncological outcomes of stage T2a and T2b

INTRODUCTION: We aimed analyzing the perioperative and oncological outcomes of >7 cm renal tumors treated with open radical nephrectomy.
METHODS: We retrospectively reviewed records of 36 cases undergoing open radical nephrectomy due to T2 clinical stage (>7 cm) between June 2010 and October 2015. Five cases were excluded which have pathology with oncocytoma, angiomyolipoma and ksanthagranulamatousis pyelonephritis. The cases were divided into 2 groups: T2a (7-10 cm) and T2b (<10 cm). The cases demographics, tumor characteristics, perioperative and oncological outcomes were compared.
RESULTS: Of the 31 cases, 23 (71%) had tumors stage T2a and 8 (29%) had tumors clinical stage T2b. The tumor stage was more often upstaged 8 cases (34%) in 23 patients at <10 cm, 4 cases (50%) in 8 patients at >10 cm. The clinical stage correlated with the pathologic size in 61% of the patients. A total of 9 cases (29%) developed recurrence, including 5 (16%) with local and 4 (13%) with distant recurrence. The sites of distant recurrence included lung in 2, brain in1 and bone in 1 case.
DISCUSSION AND CONCLUSION: The significant predictors of recurrence were papillar histological variant, high Fuhrman grade, renal vein invasion and perinephric extension. Stage T2b increased recurrence risk but not alone.

Büyük renal kitlelerde radikal nefrektomi: T2a ve T2b renal tümörlerde perioperatif ve onkolojik sonuçlarýn deðerlendirilmesi

GÝRÝÞ ve AMAÇ: Yedi cm ve üzerindeki renal malignitelerde açýk radikal nefrektominin perioperatif ve onkolojik sonuçlarýnýn deðerlendirilmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Haziran 2010 ile Ocak 2015 tarihleri arasýnda T2 klinik evre (>7 cm) ile açýk radikal nefrektomi yapýlan 36 olgu retrospektif olarak deðerlendirildi. Operasyon sonrasý nihai patolojileri onkositom, anjiyomyolipom ve ksantogranülamatöz piyelonefrit gelen 5 olgu çalýþma dýþý býrakýldý. Olgular klinik evrelerine göre 2 gruba ayrýldý: T2a (7-10 cm) ve T2b (<10 cm). Olgularýn demografik özellikleri, tümörün karakteristik özellikleri, perioperatif ve onkolojik sonuçlar kayýt edilerek karþýlaþtýrýldý.
BULGULAR: Çalýþmaya alýnan 31 olgunun 23 tanesinin (%71) klinik evresi T2a, 8’inin ise (%29) T2b. Tümör boyutu 10 cm altýnda bulunan 23 olgunun 8 tanesinde (%34), T2b tümörlerde ise 4 olguda (%50) patolojik evre artmýþtýr. Olgularýn %61’inde klinik ve patolojik evre korele bulunmuþtur. Toplam 9 olguda (%29) rekürrens geliþmiþ bunlarýn 5 tanesi (%16) lokal nüks, 4 tanesi ise (%13) uzak metastaz þeklindedir. Uzak metastazlarýn 2 tanesi akciðere birer tanesi ise kemik ve beyine olmuþtur.
TARTIÞMA ve SONUÇ: Rekürrens ile papiller histolojik varyantýn, yüksek Fuhrman derecesinin, vasküler tutulumun ve perinefritik yayýlýmýn iliþkili olduðu gözlenmiþtir. Klinik T2b varlýðýnýn rekürrens ihtimalini artýrdýðý ancak tek baþýna rekürrensle iliþkisi olmadýðý gösterilmiþtir.