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Registration Number

0215U003243, 0112U000019 , R & D reports

Title

To improve the indications and methodics of organ sparing surgery in patients with renal cell cancer based on the study morphological and functional changes in the kidneys

Head

Stakhovskyy Eduard Oleksandrovich,

Registration Date

22-01-2015

Organization

Ukrainian Research Institute of Oncology and Radiology

Description

The object of study - 291 patient with renal cell carcinoma. Purpose - to reduce the level of disability, to improve the efficiency of diagnosis and treatment of kidney cancer by improving the indications, operative technique and requirements for organ surgery. Methods: clinical, laboratory, radiation, statistics. Revealed that partial nephrectomy with the central ischemia leads to irreversible changes in the parenchyma and fair progressive decrease in both total glomerular filtration rate and glomerular filtration rate on the affected side 11.4% and 28.5%, respectively (p <0.05). At the same time, local ischemia does not cause leakage reduction of renal function. Established that postoperative complications in kidney resection directly correlated with tumor size. Improving the technology of kidney resection due to: the transabdominal approach, methodology rotation kidneys, the use of local renal ischemia and imposing double row seams to reduce the level of postoperative complications to 6.1%. A new evaluation system tumors of the kidney (NCIU- nephrometry) to optimize and refine the indications for resection of the kidney to save her function, prevent the development of renal failure and the resulting disability patients. It is shown that the choice of indications for resection of the kidney is the most valid indicators of the amount saved renal parenchyma and tumor localization (95,7% sensitivity and 94,1% specificity) than the size of the tumor. Developed multimodal program "fast-track surgery" in patients with renal cell carcinoma at the resection of the kidney reliably reduce postoperative day bed to (4,8 ± 1,7) (p <0.0002) with a similar level of postoperative complications. Found no significant difference in index of cumulative patient survival after resection (98.4%) and nephrectomy (96.3%) in the period up to 32 months (p = 0.68). It is proved that nefroprotektorna therapy based on ACE inhibitors enalapril, dezahrehantnoho drug pentoxifylline, osmotic diuretic mannitol in combination with the extended local anesthetic epidural analgesia in the perioperative period contributes to the preservation of kidney function after resection of early and remote postoperative period (p = 0.0011 (6 months) and p = 0.0156 (12 months). The results of research are introduced in the National Cancer Institute, Odessa Regional Clinical Oncology Center, Lviv State Medical Oncology - Diagnostic Center. Forward assumptions about the object of study - improvement indications, operative techniques and requirements for organ surgery in renal - cell carcinoma. RENAL CELL CARCINOMA, PARTIAL NEPHRECTOMY, NCIU- NEPHROMETRIA, NEPHROPROTECTIVE THERAPY.

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Вітрук Юрій Васильович
Войленко Олег Анатолійович
Вукалович Петро Семенович
Гаврилюк Оксана Миколаївна
Климчук Людмила В'ячеславівна
Лісний Іван Іванович
Стаховський Едуард Олександрович
Стаховський Олександр Едуардович