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Master Thesis

Prise en charge conservatrice mini-invasive par laparoscopie avec assistance robotique ou techniques ablatives des tumeurs du rein cliniquement localisées : l'expérience du CHU de Bordeaux

Abstract : Background: New mini-invasive approaches therapy emerged for the treatment of localized clinical renal cancer (RCC). Robot Assisted laparoscopic Partial Nephrectomy (RAPN) and thermal ablation (TA) were used recently in our institution. Objectives are to review our activity and secondly to describe outcomes of oncologic, renal function and morbidity. Patients and Methods: We performed a retrospective review, RAPN and TA data were extracted from UroCCR (French National Database on Kidney Cancer) from 2003 to end of 2015. Statistical analysis used by Chi² and Wilcoxon tests. The log-rank test was used to determinate predictive factors of local recurrence in univariate and multivariate analysis. Results: 397 patients were included, 232 treated by RAPN and 165 by TA. RAPN patients were younger (61 vs 73 yo, p<0,001), had a lower ASA score, less single kidney (4,9% vs 34,8%, p<0,001) and less bilateral tumor (p<0,001). 342 patients had proved malignant tumor, the rate of local recurrence, metastatic and death were lower with NPRA (3%, 2,4%, 1,9%, respectively) than TA (17,5%, 10,3%, 13,8%, p<0,001). In multivariate analysis, the only predictive factor of local recurrence was endophytic tumor OR 3.51 (1.0112.20), p=0,04, but without statistically difference for robotic treatment 0.39 (0.11-1.37), p=0,14, and history of prior RCC 4.72 (0.92-24.3), p=0,06. There was no difference of glomerular filtration rate between the 2 groups (-5,3 vs -5,6 ml/min/1.73m², p=0,32). In post-operative, 34 NPRA patients had complication and 18 in TA group (14,6% vs 10,8%, p=0,08). NPRA group had more transfusion (7,7% vs 0,6%, p<0,001) and higher Clavien complication (p=0,016). Conclusions: NPRA allows better rate of local recurrence than TA. Metastatic and overall rate seem to be more dependent of history of patient than treatment used. There is no difference on renal function detriment rate, however TA had fewer complication.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01389755
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Saturday, October 29, 2016 - 11:49:06 AM
Last modification on : Wednesday, August 23, 2017 - 4:33:56 PM

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Yohann Grassano-Lavenu. Prise en charge conservatrice mini-invasive par laparoscopie avec assistance robotique ou techniques ablatives des tumeurs du rein cliniquement localisées : l'expérience du CHU de Bordeaux. Médecine humaine et pathologie. 2016. ⟨dumas-01389755⟩

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