Skip to main content
SpringerLink
Log in

Offene und minimal-invasive partielle Nephrektomie

Komplikationsmanagement

Open and minimally invasive partial nephrectomy

Management of complications

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Aktuelle Leitlinien empfehlen bei Nierentumoren zunehmend ein organerhaltendes Operationsverfahren. Sowohl die offen-chirurgischen wie auch die minimal-invasiven Operationstechniken sind etabliert. In der Literatur sind unterschiedliche Systeme zur systematischen Evaluierung von Komorbiditäten und Komplikationen berichtet worden. Bereits im Rahmen der Indikationsstellung und präoperativen Planung vor partieller Nephrektomie ist zu empfehlen ein detailliertes Risikoassessment hinsichtlich zu erwartender Komplikationen vorzunehmen. Im Wesentlichen sollten hierbei die beiden entscheidenden Faktoren, die Komorbiditäten des Patienten und der Komplexitätslevel des Tumors bewertet werden, um die bestmögliche Patientenselektion für eine partielle Nephrektomie und die Festlegung des Operationsverfahrens zu erreichen.

Abstract

Current guidelines increasingly recommend organ-preserving surgical procedures in the treatment of renal tumors. Both the open surgical and minimally invasive surgical techniques are well established. In the literature, various systems for the systematic evaluation of comorbidities and complications have been reported. Already while taking the patient’s history and preoperative planning prior to partial nephrectomy, it is recommended that a detailed risk assessment be carried out regarding expected complications. Essentially the two critical factors – the comorbidities of the patient and anatomic complexity level of the tumor – should be evaluated in order to achieve the best possible selection of patients for a partial nephrectomy and the determination of the surgical method.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Bishoff JT, Allaf ME, Kirkels W et al (1999) Laparoscopic bowel injury: incidence and clinical presentation. J Urol 161:887–890

    Article  CAS  PubMed  Google Scholar 

  2. Breda A, Finelli A, Janetschek G et al (2009) Complications of laparoscopic surgery for renal masses: prevention, management, and comparison with the open experience. Eur Urol 55:836

    Article  PubMed  Google Scholar 

  3. Castilho LN, Fugita OE, Mitre AI et al (2001) Port-site tumor recurrences of renal cell carcinoma after videolaparoscopic radical nephrectomy. J Urol 165:519

    Article  CAS  PubMed  Google Scholar 

  4. Charlson ME, Pompei P, Ales K et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373

    Article  CAS  PubMed  Google Scholar 

  5. Dash A, Vickers AJ, Schachter LR et al (2006) Comparison of outcomes in elective partial vs radical nephrectomy for clear cell renal cell carcinoma of 4–7 cm. BJU Int 97:939

    Article  PubMed  Google Scholar 

  6. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205

    Article  PubMed Central  PubMed  Google Scholar 

  7. Dripps RD (1963) New classification of physical status. Anesthesiology 24:111

    Google Scholar 

  8. Fahlenkamp D, Rassweiler J, Fornara P et al (1999) Complications of laparoscopic procedures in urology: experience with 2,407 procedures at 4 German centers. J Urol162:765–771

  9. Ficarra V, Novara G, Secco S et al (2009) Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) classification of renal tumours in patients who are candidates for Nephron-Sparing Surgery. Eur Urol 56:786

    Article  PubMed  Google Scholar 

  10. Go AS, Chertow GM, Fan D et al (2004) Chronic kidney disease and the risk of death, cardiovascular events and hospitalization. N Engl J Med 351:13

    Article  Google Scholar 

  11. Huang WC, Levey AS, Serio AM et al (2006) Chronic kidney disease after nephrectomy in patients with renal corticoid tumors: a retrospective cohort study. Lancet Oncol 7:735

    Article  PubMed Central  PubMed  Google Scholar 

  12. Kaouk JH, Gill IS (2002) Laparoscopic radical nephrectomy: morcellate or leave intact? Leave intact. Rev Urol 4:38

    PubMed Central  PubMed  Google Scholar 

  13. Kovacs G, Akhtar M, Beckwith BJ et al (1997) The Heidelberg classification of renal cell tumours. J Pathol 183:131–133

    Article  CAS  PubMed  Google Scholar 

  14. Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853

    Article  PubMed  Google Scholar 

  15. Lee JH, You CH, Min GE et al (2007) Comparison of the surgical outcome and renal function between radical and nephron-sparing surgery for renal cell carcinomas. Korean J Urol 48:671

    Article  Google Scholar 

  16. Little JP (1995) Consistency of ASA grading. Anaesthesia 50:658

    CAS  PubMed  Google Scholar 

  17. Ljungberg B, Cowan NC, Hanbury DC et al (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58:398

    Article  PubMed  Google Scholar 

  18. Matin S, Abreu S, Ramani A et al (2003) Evaluation of age and comorbidity as risk factors after laparoscopic urological surgery. J Urol 170:1115

    Article  PubMed  Google Scholar 

  19. Patel HD, Kates M, Pierorazio PM et al (2014) Balancing cardiovascular and cancer death among patients with small renal mass: modification by cardiovascular risk. BJU Int. doi:10.1111/bju.12719 (Epub ahead of print)

  20. Porpiglia F, Volpe A, Bilia M et al (2008) Laparoscopic versus open partial nephrectomy: analysis of the current literature. Eur Urol 53:732

    Article  PubMed  Google Scholar 

  21. Ramani AP, Desai MM, Steinberg AP et al (2005) Complications of laparoscopicpartial nephrectomy in 200 cases. J Urol 173:43–47

    Article  Google Scholar 

  22. Robson CJ, Churchill BM, Anderson W (1969) The results of radical nephrectomy for renal cell cancer. J Urol 101:44

    Google Scholar 

  23. Roos FC, Hampel C, Thüroff JW (2009) Renal cancer surgery in the elderly. Curr Opin Urol 19:459

    Article  PubMed  Google Scholar 

  24. Porpiglia F, Volpe A, Billia M, Scarpa RM (2008) Laparoscopic versus open partial nephrectomy: analysis of the current literature. Eur Urol 53:732–743

    Article  PubMed  Google Scholar 

  25. Simmons MN, Gill IS (2007) Decreased complications of contemporary laparoscopic partial nephrectomy: use of a standardized reporting system. J Urol 177:2067

    Article  PubMed  Google Scholar 

  26. Thompson RH, Kaag M, Vickers A et al (2009) Contemporary use of partial nephrectomy at tertiary care center in the United States. J Urol 18:993

    Article  Google Scholar 

  27. Timsit MO, Bazin JP, Thiounn N et al (2006) Prospective study of safety margins in partial nephrectomy: intraoperative assessment and contribution of frozen section analysis. Urology 67:923–926

    Article  PubMed  Google Scholar 

  28. Touijer K, Jacqmin D, Kavoussi L (2010) The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications. Eur Urol 57:214

    Article  PubMed  Google Scholar 

  29. Zini L, Patard JJ, Capitanio U et al (2009) The use of partial nephrectomy in European tertiary care centers. Eur J Surg Oncol 35:636

    Article  CAS  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Wülfing und U. Humke geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Abteilung für Urologie, Asklepios Klinik Altona, Paul-Ehrlich Straße 1, 22763, Hamburg, Deutschland

    C. Wülfing

  2. Urologische Klinik, Katharinenhospital, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Deutschland

    U. Humke

Authors
  1. C. Wülfing
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. U. Humke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to C. Wülfing or U. Humke.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wülfing, C., Humke, U. Offene und minimal-invasive partielle Nephrektomie. Urologe 53, 960–967 (2014). https://doi.org/10.1007/s00120-014-3512-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-014-3512-6

Schlüsselwörter

Keywords

Search

Navigation