Upload
internet
View
102
Download
0
Embed Size (px)
Citation preview
Up to DateCacircncer de rim
tratamento minimamente invasivo
Aacutelvaro SarkisProfessor Livre Docente Universidade de Satildeo Paulo
Urologista do Hospital do Servidor Puacuteblico de Satildeo Paulo
Outlinebull Nefrectomia minimamente invasiva vs
aberta para tumores 4cm a 7cmbull Crioablaccedilatildeo laparoscoacutepica vs PN para
tumores renais pequenos revisatildeo sistemaacutetica
bull Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
Nefrectomia minimamente invasiva vs aberta para
tumores 4cm a 7cm
N=280 de 2290
MSKCC
Mediana de follow-up para OPN 29 meses e MIPN 13 mo
Seguimento curtoi
Seguimento livre de recidivas e metaacutestases
EUROPEAN UROLOGY 61 (2012) 593ndash599
Nefrectomia parcial para Tumores gt 4 cm
EUROPEAN UROLOGY 61 (2012) 593ndash599
EUROPEAN UROLOGY 61 (2012) 593ndash599
9() das nefrectomias natildeo satildeo parciais
Conclusatildeo
bull LPN pode ser feita com seguranccedila em tumores gt 4 a 7cm com aumento de morbidade (fistula 7 laparoscopia vs 5 aberta)
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais
pequenos
revisatildeo sistemaacutetica
EUROPEAN UROLOGY 60 (2011) 435ndash443
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Conclusotildees
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standard
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
Outlinebull Nefrectomia minimamente invasiva vs
aberta para tumores 4cm a 7cmbull Crioablaccedilatildeo laparoscoacutepica vs PN para
tumores renais pequenos revisatildeo sistemaacutetica
bull Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
Nefrectomia minimamente invasiva vs aberta para
tumores 4cm a 7cm
N=280 de 2290
MSKCC
Mediana de follow-up para OPN 29 meses e MIPN 13 mo
Seguimento curtoi
Seguimento livre de recidivas e metaacutestases
EUROPEAN UROLOGY 61 (2012) 593ndash599
Nefrectomia parcial para Tumores gt 4 cm
EUROPEAN UROLOGY 61 (2012) 593ndash599
EUROPEAN UROLOGY 61 (2012) 593ndash599
9() das nefrectomias natildeo satildeo parciais
Conclusatildeo
bull LPN pode ser feita com seguranccedila em tumores gt 4 a 7cm com aumento de morbidade (fistula 7 laparoscopia vs 5 aberta)
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais
pequenos
revisatildeo sistemaacutetica
EUROPEAN UROLOGY 60 (2011) 435ndash443
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Conclusotildees
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standard
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
Nefrectomia minimamente invasiva vs aberta para
tumores 4cm a 7cm
N=280 de 2290
MSKCC
Mediana de follow-up para OPN 29 meses e MIPN 13 mo
Seguimento curtoi
Seguimento livre de recidivas e metaacutestases
EUROPEAN UROLOGY 61 (2012) 593ndash599
Nefrectomia parcial para Tumores gt 4 cm
EUROPEAN UROLOGY 61 (2012) 593ndash599
EUROPEAN UROLOGY 61 (2012) 593ndash599
9() das nefrectomias natildeo satildeo parciais
Conclusatildeo
bull LPN pode ser feita com seguranccedila em tumores gt 4 a 7cm com aumento de morbidade (fistula 7 laparoscopia vs 5 aberta)
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais
pequenos
revisatildeo sistemaacutetica
EUROPEAN UROLOGY 60 (2011) 435ndash443
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Conclusotildees
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standard
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
N=280 de 2290
MSKCC
Mediana de follow-up para OPN 29 meses e MIPN 13 mo
Seguimento curtoi
Seguimento livre de recidivas e metaacutestases
EUROPEAN UROLOGY 61 (2012) 593ndash599
Nefrectomia parcial para Tumores gt 4 cm
EUROPEAN UROLOGY 61 (2012) 593ndash599
EUROPEAN UROLOGY 61 (2012) 593ndash599
9() das nefrectomias natildeo satildeo parciais
Conclusatildeo
bull LPN pode ser feita com seguranccedila em tumores gt 4 a 7cm com aumento de morbidade (fistula 7 laparoscopia vs 5 aberta)
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais
pequenos
revisatildeo sistemaacutetica
EUROPEAN UROLOGY 60 (2011) 435ndash443
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Conclusotildees
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standard
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
Mediana de follow-up para OPN 29 meses e MIPN 13 mo
Seguimento curtoi
Seguimento livre de recidivas e metaacutestases
EUROPEAN UROLOGY 61 (2012) 593ndash599
Nefrectomia parcial para Tumores gt 4 cm
EUROPEAN UROLOGY 61 (2012) 593ndash599
EUROPEAN UROLOGY 61 (2012) 593ndash599
9() das nefrectomias natildeo satildeo parciais
Conclusatildeo
bull LPN pode ser feita com seguranccedila em tumores gt 4 a 7cm com aumento de morbidade (fistula 7 laparoscopia vs 5 aberta)
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais
pequenos
revisatildeo sistemaacutetica
EUROPEAN UROLOGY 60 (2011) 435ndash443
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Conclusotildees
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standard
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
Nefrectomia parcial para Tumores gt 4 cm
EUROPEAN UROLOGY 61 (2012) 593ndash599
EUROPEAN UROLOGY 61 (2012) 593ndash599
9() das nefrectomias natildeo satildeo parciais
Conclusatildeo
bull LPN pode ser feita com seguranccedila em tumores gt 4 a 7cm com aumento de morbidade (fistula 7 laparoscopia vs 5 aberta)
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais
pequenos
revisatildeo sistemaacutetica
EUROPEAN UROLOGY 60 (2011) 435ndash443
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Conclusotildees
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standard
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
EUROPEAN UROLOGY 61 (2012) 593ndash599
9() das nefrectomias natildeo satildeo parciais
Conclusatildeo
bull LPN pode ser feita com seguranccedila em tumores gt 4 a 7cm com aumento de morbidade (fistula 7 laparoscopia vs 5 aberta)
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais
pequenos
revisatildeo sistemaacutetica
EUROPEAN UROLOGY 60 (2011) 435ndash443
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Conclusotildees
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standard
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
Conclusatildeo
bull LPN pode ser feita com seguranccedila em tumores gt 4 a 7cm com aumento de morbidade (fistula 7 laparoscopia vs 5 aberta)
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais
pequenos
revisatildeo sistemaacutetica
EUROPEAN UROLOGY 60 (2011) 435ndash443
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Conclusotildees
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standard
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais
pequenos
revisatildeo sistemaacutetica
EUROPEAN UROLOGY 60 (2011) 435ndash443
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Conclusotildees
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standard
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
EUROPEAN UROLOGY 60 (2011) 435ndash443
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Conclusotildees
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standard
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Conclusotildees
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standard
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Conclusotildees
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standard
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
Crioablaccedilatildeo laparoscoacutepica vs PN para tumores renais pequenos
EUROPEAN UROLOGY 60 (2011) 435ndash443
Conclusotildees
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standard
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
Conclusotildees
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standard
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
Evoluccedilatildeo funcional e oncoloacutegica de NSS para tumores renais gt7 cm
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
5767 patients were treated for renal tumours at two
institutions from 1984 to 2009
In 91 patients elective NSS was performed for
renal tumours gt 7 cm
The median follow-up was 28 mo (range 1ndash247 mo) Twenty- seven patients (296)
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
Comparavel agrave cirurgia aberta
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
Conclusatildeo
bull NSS para tumores renais gt 7cm eacute viavel e pode ser sempre feita desde que tecnicamente factiacutevel
proposta dos autores
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
Conclusotildees geraisbull LPN pode ser feita com seguranccedila em tumores
gt 4 a 7cm com aumento de morbidade (fistula 7 lap vs 5 aberta)
bull LCA e PN satildeo opccedilotildees viaacuteveis para o tratamento de SRMs
bull LCA tem maior risco de progressatildeo localbull PN eacute gold standardrdquobull NSS para tumores renais gt 7cm eacute viavel e pode
ser sempre feita desde que tecnicamente factiacutevel
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible
n addition to a comparable oncological outcome be-
tween NSS and RN for renal tumors larger than 4
cm we have shown that increasing age ASA score
311130924 preop- erative eGFR and RN are associated
with the develop- ment of CKD in a balanced cohort
for patients treated by NSS or RN for renal
tumors 11130924 cm NSS maintains renal function with
comparable perioperative morbidity to RN It is
therefore reasonable to postulate that NSS should
be performed whenever technically feasible