Néphrectomie partielle pour tumeur rénale : évolution des pratiques sur 30 ans dans le service d’urologie du CHU de Bordeaux

Abstract : Introduction: Partial Nephrectomy (PN) is now the usual treatment for localized renal tumors. The increase of NPs performed last years is associated as a change in practices, influenced by the development of robotic surgery. The main objective of this study is to describe this evolution within the department of urology of the University Hospital Center of Bordeaux, a reference center in the management of kidney cancer. Material And Methods: this is a single-center, retrospective cohort study of all patients treated with NP for primary renal tumor at Bordeaux University Hospital before January 1st, 2017. Demographic data, tumor characteristics, surgical modalities and functional, oncologic and safety results were studied according to the period (before or after 2010) and the technique (open NP or robot-assisted). Results: a total of 693 procedures involving 678 patients were performed between 1983 and 2016. The annual number of NP increased over time and the development of robotic surgery resulted in a decrease in the number of total nephrectomies and a change in the technique of PN. Open PN (OPN) used to involve patients and tumors more complex (imperative indications and tumor complexity). Robotic-Assisted PN (RAPN) was associated with a significant decrease in median length of stay (p <0.001) and perioperative morbidity while functional and carcinologic findings were not different from those of NPO. Conclusion: in this monocentric series, the development of robotic surgery has contributed to the increase in the number of procedures and to the improvement of the results compared to the open surgery, notably in terms of length of stay and perioperative morbidity . The difference observed about complexity is explained by the gradual development of the RAPN and seems to diminish over time. Today, OPN has been replaced by RAPN, including for complex and bulky tumors. The progress associated with robotic surgery has led to the development of new techniques for clamping and tumor resection whose results need to be assested by specific studies.
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Master Thesis
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Submitted on : Friday, November 3, 2017 - 6:29:35 PM
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Nam-Son Vuong. Néphrectomie partielle pour tumeur rénale : évolution des pratiques sur 30 ans dans le service d’urologie du CHU de Bordeaux. Médecine humaine et pathologie. 2017. ⟨dumas-01628635⟩

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