Publication: Análisis comparativo entre la nefrectomía radical abierta y la laparoscópica en los pacientes con carcinoma renal
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2021-07-16
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Universidad Complutense de Madrid
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Abstract
La incidencia de cáncer renal está aumentando en los últimos años. Existen diversos factores que han favorecido este aumento de la incidencia entre los que se encuentran la mejor disponibilidad y calidad de las técnicas diagnósticas, así como el envejecimiento cada vez más acusado de nuestras poblaciones. La primera nefrectomía laparoscópica fue llevada a cabo por Clayman et al. en 1990. Actualmente se considera que el acceso laparoscópico a la nefrectomía radical presenta ventajas frente al clásico acceso abierto recomendándolo las guías europeas con un nivel de evidencia 1b con grado de recomendación B para tumores en estadio menor o igual a cT2.
Estas recomendaciones están basadas en estudios la mayoría retrospectivos y con poblaciones relativamente pequeñas. En dichas series se sugiere que el acceso laparoscópico a la nefrectomía presenta ventajas como: menos sangrado, menos necesidades de analgesia y menor estancia hospitalaria. No obstante, en cuanto a resultados oncológicos, la revisión de las series de la literatura pone de manifiesto que no existen diferencias en supervivencia global (SG), cáncer específica (SCE) o supervivencia libre de recidiva (SLR), con un nivel de evidencia 2a en las guías europeas.
Desgraciadamente, aunque existen múltiples estudios retrospectivos que comparan ambas técnicas en los términos mencionados, se han realizado con poblaciones pequeñas y no existen apenas estudios prospectivos. Los disponibles no son aleatorizados y presentan sesgos importantes muchos de ellos... HIPÓTESIS Y OBJETIVOS: En base a lo descrito previamente podemos presuponer que el abordaje laparoscópico es, al menos, comparable al abierto en términos de supervivencia, complicaciones, estancia hospitalaria y tiempo quirúrgico. El objetivo de la presente tesis es realizar una comparación de la efectividad del abordaje laparoscópico frente al abierto para la nefrectomía radical en los pacientes con cáncer renal en estadio menor o igual a cT3a...
Incidence of renal cancer is still raising nowadays. There are several factors that have influenced this phenomenon such as the better quality and availability of multiple diagnostic tools or the ageing population in developed countries. The first laparoscopic radical nephrectomy (LRN) was performed by Clayman et al in 1990. Nowadays, laparoscopic access to radical nephrectomy is considered to have some advantages over the open access. This is why the guidelines of the European Association of Urology (EAU) recommend it for tumours in a cT2 stage or lower with a level of evidence 1b and a B level of recommendation. These recommendations are based in retrospective studies mainly. In those studies, it is suggested that laparoscopic access to nephrectomy presents: less blood loss, less analgesic requirements in the postoperative period and shorter hospital stay. Despite this, review of the literature reveals no differences in terms of overall (OS), cancer-specific (CSS) or recurrence free survival (RFS) with a level of evidence 2a in EAU guidelines. Unfortunately, despite finding several retrospective studies comparing both techniques, most of them have been carried out with small populations and few prospective, non-randomized studies can be found with low methodological quality. The aim of this thesis was to make a comparative analysis of the effectivity of the laparoscopic approach to radical nephrectomy compared with open radical nephrectomy (ORN) in patients with renal cancer in a cT3a stage or lower. We analyzed the evolution over time of: clinical manifestations, tumoral size at diagnosis and surgical access to nephrectomy. Furthermore, an evaluation of surgical time, postoperative complications, hospital stay, OS, CSS and RFS was performed...
Incidence of renal cancer is still raising nowadays. There are several factors that have influenced this phenomenon such as the better quality and availability of multiple diagnostic tools or the ageing population in developed countries. The first laparoscopic radical nephrectomy (LRN) was performed by Clayman et al in 1990. Nowadays, laparoscopic access to radical nephrectomy is considered to have some advantages over the open access. This is why the guidelines of the European Association of Urology (EAU) recommend it for tumours in a cT2 stage or lower with a level of evidence 1b and a B level of recommendation. These recommendations are based in retrospective studies mainly. In those studies, it is suggested that laparoscopic access to nephrectomy presents: less blood loss, less analgesic requirements in the postoperative period and shorter hospital stay. Despite this, review of the literature reveals no differences in terms of overall (OS), cancer-specific (CSS) or recurrence free survival (RFS) with a level of evidence 2a in EAU guidelines. Unfortunately, despite finding several retrospective studies comparing both techniques, most of them have been carried out with small populations and few prospective, non-randomized studies can be found with low methodological quality. The aim of this thesis was to make a comparative analysis of the effectivity of the laparoscopic approach to radical nephrectomy compared with open radical nephrectomy (ORN) in patients with renal cancer in a cT3a stage or lower. We analyzed the evolution over time of: clinical manifestations, tumoral size at diagnosis and surgical access to nephrectomy. Furthermore, an evaluation of surgical time, postoperative complications, hospital stay, OS, CSS and RFS was performed...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 05/02/2021