1 / 17

We don’t take out kidneys anymore! (or why we try not to!!) Dr Dennis Gyomber

We don’t take out kidneys anymore! (or why we try not to!!) Dr Dennis Gyomber MB BS , FRACS ( Urol ) Urological Surgeon University of Melbourne, Department of Surgery, Austin Hospital Austin Hospital , Urology Unit, Melbourne. Evolution of renal tumours. Physician tumour

jered
Download Presentation

We don’t take out kidneys anymore! (or why we try not to!!) Dr Dennis Gyomber

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. We don’t take out kidneys anymore!(or why we try not to!!) Dr Dennis Gyomber MB BS , FRACS (Urol) Urological Surgeon University of Melbourne, Department of Surgery, Austin Hospital Austin Hospital , Urology Unit, Melbourne

  2. Evolution of renal tumours • Physician tumour • Triad of pain, palpable mass and haematuria • Increased use of imaging • 70% of tumours are Asx and less than 4cm

  3. Laparoscopic Surgery& organ preservation • Benefits of Laparoscopic surgery are well established • Equivalent oncological outcomes • Minimal blood loss • Quicker recovery J Urol 174 Oct 2005 • Organ Preservation • Breast Cancer evolved from Radical Mastectomy to Lumpectomy • Has this concept been embraced for renal surgery ??

  4. Radical Nephrectomy > partial Nephrectomy • SEER database on renal surgery (24,535) • 16, 495 (67%) tumours were < 7cm • 90.3% were treated by Radical nephrectomy Adapted from Cloutier et al EAU 2009 • South Korean data • 252 (84.3%) were < 7cm • 89.3% underwent Radical Nephrectomy Adapted from Cho et al EAU 2009

  5. Myth • “Doctor, can I live with one Kidney?” • “Sure you can there are plenty of people who have donated a kidney and they are fine”. BUT Donor Nephrectomy does not equal Radical Nephrectomy

  6. Renal cancer patients have lower eGFR than doners

  7. eGFR are independent risk factors for • Cardiovascular events • Increased frailty through bone and muscle disease • Decreased physical and cognitive function • Higher hospitalisation rates • Increased vulnerability to Hospital related complications i.e. infections, drugs, therapeutic and diagnostic procedures • Overall decreased quality of life.

  8. MSKCC data 3 year probability of developing CRI based on the type of surgery performed Huang et al Lancet Onol 2006

  9. Importance of eGFR Thompson J Urol 2008

  10. MSKCC 2008 2991 patients <4cm in size • 81% - Radical Nephrectomy 19% - Partial Nephrectomy • Outcomes measures • cardiovascular events and death • 4 year follow up on multivariate analysis • RN associated with • 1.38 x increased overall mortality • 1.4 x greater number of cardiovascular events

  11. Huang J Urol 2009

  12. PN preserves eGFR

  13. Summary • Most tumours are Asx and small (4cm or less) • Ideal for renal preservation surgery • Maintaining eGFR is important for cardiovascular health • We now have the skills to offer organ preservation

  14. THANK YOU! Dr Dennis Gyomber MB BS , FRACS (Urol) Urological Surgeon University of Melbourne, Department of Surgery, Austin Hospital Austin Hospital , Urology Unit, Melbourne

More Related