%0 Journal Article
%T Practice Trends in the Surgical Management of Renal Tumors in an Academic Medical Center in the Past Decade
%A Matheus Tannus
%A F¨¢bio Sep¨²lveda
%A Thom¨¦ Pinheiro
%A C¨¢ssio Andreoni
%J ISRN Endoscopy
%D 2013
%R 10.5402/2013/945853
%X Objectives. To evaluate the trends of surgical treatment of the renal tumor in an academic medical center. Methods. Between 2001 and 2010, 505 were treated surgically at the Federal University of Sao Paulo for renal tumors. The following variables were observed and analyzed according to their evolution through time: frequency and types of surgeries performed, operative time, hospital stay, and warm ischemia time for partial nephrectomy. Results. An increase in the frequency of laparoscopic radical nephrectomies, open partial nephrectomies, and laparoscopic partial nephrectomies was observed when comparing the periods from 2001 to 2005 (4.3%, 2.6%, and 12.6%, resp.) and from 2006 to 2010 (13.2%, 18.6%, and 20.2%, resp.; ). The average of operative time, hospital stay, and tumor size diminished (from 211.7 to 177.17 minutes, from 5.52 to 4.22 days, and from 6.72 to 5.29£¿cm, resp.) when compared to the periods from 2001 to 2005 and from 2006 to 2010 ( , , resp.). Conclusion. As time goes by, there has been a significant reduction in the hospital stay time, surgery time, and size of renal tumor in patients treated surgically. The frequencies of minimally invasive and nephron-sparing surgeries have increased over the last years. 1. Introduction Surgery continues to be the main form of treatment for a renal tumor. The renal cell carcinoma (RCC) is the main malignant renal tumor and is one of the most lethal urologic cancers. It includes a number of distinct subtypes derived from the various parts of nephrons, each one with a unique genetic base and tumor biology [1]. The goal of the surgery is to remove the tumor with an adequate surgical margin. In 1969, Robson and colleagues established the radical nephrectomy (RN) as ¡°gold standard¡± procedure to heal renal tumors [2]. However, studies have demonstrated that patients who undergo RN have a greater chance of deterioration of the renal function [3]. At present, over 60% of renal tumors are incidentally diagnosed in ultrasound scans or in computerized tomographies conducted for other reasons [4]. These tumors are smaller and have a lesser chance of developing metastases [5]. More recently, based on knowledge about chronic renal disease [6] allied to improved technology, minimally invasive and nephron-sparing surgeries are being increasingly used in smaller renal tumors [7, 8]. However, despite the significant amount of scientific papers revealing the advantages of minimally invasive and nephron-sparing surgery, most urologists still perform open and radical nephrectomies, even for small renal tumors [9].
%U http://www.hindawi.com/journals/isrn.endoscopy/2013/945853/