Результаты модифицированного хирургического доступа к регионарным лимфоузлам в лечении рака почки

Аннотация

Purpose: To study the long-term results of a new method of surgical access to the main vessels and regional renal cancer lymphocollectors. Materials and methods: In the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology, as well as in its Tashkent City Branch from 2010-2015, 96 patients were treated. The distribution of patients by sex and age intervals is shown in the figure. There male predominance 51 (53.1%) versus 45 (46.9%) women, the ratio was 1.1: 1. The age range is from 21 to 75 years, the average age of patients was 56.0 ± 1.3 years. From 96 patients participating in the study, a tumor process was established in 51 (53.1%) men and 45 (46.9%) women. The number of patients with metastatic lesion of regional lymph nodes were followings: N1 - 10 (10.5%), N2-6 (6.2%). In the remaining 80 (83.3%) patients, regional lymph nodes were intact. All patients underwent radical-extended nephrectomy. After laparotomy, the ascending and transversely dividing colon of the large intestine is mobilized, the loops of the intestines are pulled back with a moist towel up and to the left. After this, the back of the peritoneum is opened over the projection of the aorta from the level of the aortic bifurcation, the top with the dissection of the triceal ligament is opened beyond the peritoneal space. Results: The character of the histological form of the kidney tumors established after the operation by morphological examination were followings: the clear cell cancer in 77 (80.2%), papillary cancer in 8 (8.3%), unclassifiablc cancer in 4 (4.2% ), chromophobic cancer - in 7 (7.3%). At stage 1, no metastasis was detected. In stage 2 metastasis was noted in 4.2% of cases. In stage 3, 18.0% metastasis was detected. In 27.3% of patients metastasis took place in the 4th stage. All 13 patients (13.5%) had postoperative progression of the disease revealed. Conclusion: In renal tumors with Ti, we recommend performing selective lymphodisection, that is removing of first-order lymph nodes for precise staging. For T2.4N0.2M0 tumors, it is recommended to perform an extended lymph dissection from the level of the diaphragm legs to the aortic bifurcation. The development of surgical access with a cut of the triceal ligament with extended lymph node dissection of the renal cancer and a small number of postoperative complications make it possible to apply it in all patients with renal cancer.