12. Reassessing the Lymph Node Staging for RCC Dimashkieh HH et al. J Urol 2006; 176: 1978-1983 ENE =Extranodal extension 12
13. Tumour, Nodes, Metastases Staging System Nx Regional Lymphnodes Idem cannot be assessed N0 Regional lymphnodes Idem negative N1 Metastasis to a 4 or less positive nodes single node (no extranodal invasion) N2 Metastasis in > > 4 positive nodes 1 Lymph node (extranodal invasion) TNM, 2002 TNM, ?? V.Ficarra 13
14. What to do in cN+ patients ? Radical Nephrectomy and Robson-LND 14
25. Elective Nephron-sparing Surgery for Localized RCC Valdez-Mendoza, 2008 N° pts 5-y DFS (% ) Local recurr. (% ) Median FU (mos) Van Poppel et al . (1998) [44] 51 98 0 75 Herr (1999) [9] 70 97 1.5 120 Hafez et al . (1999) [10] 45 100 0 35 Lee et al . (2000) [4] 37 100 0 40 Lau (2000) [23] 189 98 1 44 Filipas et al . (2000) [49] 180 98 1.6 56.4 McKiernan et al . (2002) [22] 117 100 1.2 25 Kural et al . (2003) [51] 50 100 0 33.1 Patard et al . (2004) [11] 379 97.8 0.8 51
26. Overall Survival Cure rates of Partial and Radical Nx for small RCC are similar Eur.Urol. 2011 26
27.
28. Partial Nephrectomy for Small Renal Masses D.C. Miller, 2006. SEER Data Part. Nx in 9.6% of cases of RCC (1988-2001) % 4 28
78. HIFU 20-40 W/cm 2 1600-2000 W/cm 2 DEPT. UROLOGY, UNIVERSITY OF VIENNA Still experimental 77
79.
80.
81. Renal Cancer Treatment Kim, J Urol ‘03 McDougall, J Urol ‘96 Corman, Br J Urol ‘00 Lotan, Br J Urol ‘05 Kercher, Surg End ‘03 80 Rad Nx Open Part.Nx Lap Part.Nx Ablation Morbidity 15% 16% 20% 2-6% Recovery 35 days 33 days 12 days 1 day Mortality 2% 1.6% <1% <0.5% Hospital Stay 5 days 3 days 1.9 days 0.5-1 day Cost $31,000-35,000 $26,000-32,000 $26,000-32,000 $5,000-10,000
82.
Notes de l'éditeur
SRMs: small renal masses NSS: nephron-sparing surgery
In conclusions,
In conclusions,
In conclusions,
Moving to locally advanced RCC, As you know, they are classified as pT3 and pT4. The former group includes tumours invading perirenal fat and/or ipsilateral adrenal gland, T3a, as well as those presenting with thrombosis within the renal vein or the vena cava below or above the diaphragm. Moreover, T4 RCC were characterized by tumours extending beyond the gerota fascia.
LPN: laparoscopic partial nephrectomy OPN: open partial nephrectomy
RFA: radiofrequency ablation MINS: minimally invasive nephron-sparing AS: active surveillance