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d%> d= _ d=> Localized treatment of renal cancer generally uses surgical treatment, regional lymph node dissection, adrenalectomy and ablation technology. These professional vocabulary are relatively difficult to understand. Drug Shipping uses concise and popular language to explain to readers. The introduction is as follows:
Surgical treatment of renal cancer
Surgical resection is still an effective treatment method for the treatment of limited-stage renal cancer. The surgical options include radical nephrectomy or nephron-sparing surgery. The formulas will be explained separately later. Both procedures have their own advantages and risks that need to be balanced between long-term renal function and the expected time to be free of disease recurrence.
1. Radical nephrectomy
Radical nephrectomy includes the removal of perinephric fascia, perinephric fat, regional lymph nodes and ipsilateral adrenal gland. Radical nephrectomy is preferred if the tumor invades the inferior vena cava. About half of these patients achieve long-term survival. Open, laparoscopic, and robot-assisted surgery can also be performed for radical nephrectomy. Long-term follow-up shows that laparoscopic surgery is equivalent to open surgery.
Initially, nephron-sparing surgery is only used for patients who undergo radical resection, which will result in functional non-kidney and require dialysis, including solitary kidney, bilateral primary contralateral renal insufficiency, etc.
2. Partial nephrectomy
Partial nephrectomy has now obtained prognostic data equivalent to that of radical nephrectomy, while patients undergoing radical nephrectomy have an increased risk of chronic kidney disease. Based on population data, chronic kidney disease Kidney disease can increase the incidence and mortality of cardiovascular disease. Compared with radical nephrectomy, partial nephrectomy can preserve renal function, reduce overall mortality and reduce the occurrence of cardiovascular events.
Nephron-sparing surgery may also be considered for hereditary kidney cancers such as syndrome. Nowadays, nephron-sparing surgery is increasingly performed on patients with lesions of , (maximum diameter) and normal contralateral renal function, and its efficacy is similar to radical nephrectomy.
Pharmaceutical shipping advice: Radical nephrectomy should not be considered if nephron-sparing surgery is available. Recently, more and more studies have shown that partial nephrectomy can achieve better survival prognosis than radical nephrectomy for early-stage renal cancer.
Opinions on drug delivery for nephrectomy surgery
1. Some limited postoperative follow-up studies have shown that the tumor prognosis of laparoscopic partial nephrectomy is equivalent to that of open surgery. Partial nephrectomy should provide optimal local tumor control while minimizing blood occlusion time to ideally less than minutes. However, some localized renal cancers may not be suitable for partial nephrectomy due to local invasion or location factors.
2. For experienced surgeons, the efficacy and prognosis of laparoscopic surgery, robot-assisted surgery, and open partial nephrectomy are generally equivalent.
3. If medical conditions permit, patients with stage I and stage III lesions should undergo surgical resection.
Regional lymph node dissection
1. The role of regional lymph node dissection
Regional lymph node dissection does not provide therapeutic benefits but can provide corresponding prognostic information. This is because almost all patients with lymph node metastasis have lymph node metastasis even if they have lymph node dissection. Distant metastases also appear quickly after dissection. Lymph node dissection is not intended to be therapeutic but to provide prognostic information because patients with involvement of all lymph nodes often develop subsequent recurrence or distant metastasis despite lymphadenectomy.
According to the latest announcement of a phase III clinical study by the European Organization for Research and Treatment of Oncology (r), which compared radical nephrectomy with lymphadenectomy and nephrectomy alone, the results showed that the two groups had better overall survival, disease There was no significant difference in time to progression or progression-free survival but pathological characteristics of the primary tumor such as nuclear grade, sarcomatous component, tumor size, stage, and tumor necrosis are all factors that influence the likelihood of lymph node invasion during radical nephrectomy.
Assessment of lymph node status is based on imaging (/r ) and surgical findings. However/r small metastases in normal lymph nodes may not be detected.
The Kidney Cancer Council recommends regional lymph node dissection for patients with palpable lymph nodes during surgery or those with enlarged lymph nodes on preoperative imaging. Patients who are found to have enlarged lymph nodes and those whose lymph nodes appear normal but require adequate staging information.
Adrenalectomy
Ipsilateral adrenalectomy should be considered in patients with large lesions in the upper pole of the kidney or in patients with abdominal abnormalities of the adrenal gland. Patients whose imaging studies indicate normal adrenal glands or who are not high-risk based on tumor size and location are not suitable for adrenalectomy.
Close monitoring and ablation technology
1. The definition of close monitoring is that close monitoring of the initial tumor using imaging means can delay the time for intervention. It is suitable for patients with early stage, small tumors and those with other diseases and a low probability of dying from kidney cancer.
2. For some selected patients, especially the elderly and patients with high-risk physical conditions, close monitoring or radiofrequency ablation can also be used as an alternative treatment. Currently, there is no randomized phase III clinical study comparing radiofrequency ablation with surgical resection.