Andrushchuk Uladzimir, Ostrovsky Yury, Krasny Sergey, Polyakov Sergey, Zharkov Vladimir, Rolevich Alexander, Kurganovich Svetlana, Krutau Valery, Amelchanka Siarhei G
Republican Scientific and Practical Centre 'Cardiology', Department of Cardiac Surgery, Minsk, Belarus.
N.N. Alexandrov National Cancer Centre, Department of Urology, Minsk, Belarus.
Cent European J Urol. 2017;70(4):356-361. doi: 10.5173/ceju.2017.1337. Epub 2017 Sep 19.
To evaluate outcomes of simultaneous and staged surgery in patients with kidney tumors and concomitant cardiac disease.
Between October 2001 and October 2015, fifteen patients (Group 1) underwent simultaneous surgery and fourteen patients (Group 2) underwent staged surgery. 89.7% were males (26/29), and the mean age was 60.8 ±1.16 years. Locally advanced cancers (Stage III) were registered in the two groups in 11 vs. 3 patients (p = 0.016) and localized (Stage I) disease in 2 vs. 10 (p = 0.007), respectively. 18 patients (62%) were operated for coronary heart disease, while 10 patients (35%) underwent surgery for valvular heart disease. Nephrectomy was performed in 14rs 5 patients respectively (p = 0.003) while partial nephrectomy in 1rs 7 patients (p = 0.005).
In the two groups, the 30-day mortality was 13% (2 cases) and 7% (1 case), p = 1.0, and major hospital complications were observed in 3 (20%) and 2 (14%) cases, respectively, p = 0.53. The median follow-up in Group 1 and Group 2 was 87 months (range, 23.3 to 146.8 months) and 39 months (range, 3.9 to 98 months), respectively, p = 0.001. Three-year overall survival was 73.3 ±11.4% (95% CI 50.5-96.1) and 77.9 ±11.3%, respectively, p = 0.70, and three-year disease-free survival was 83.9 ±10.4% and 75.0 ±21.7%, respectively, p = 0.91.
Simultaneous and staged surgery for kidney tumors and concomitant cardiac disease are feasible procedures. Patients with advanced tumors and complicated disease course can benefit from early intervention and consequently a simultaneous approach can be a preferred option for them. For localized renal tumors, staged surgery should be used.
评估肾肿瘤合并心脏病患者同期手术和分期手术的效果。
2001年10月至2015年10月期间，15例患者（第1组）接受了同期手术，14例患者（第2组）接受了分期手术。89.7%为男性（26/29），平均年龄为60.8±1.16岁。两组中局部晚期癌症（Ⅲ期）分别有11例和3例（p = 0.016），局限性（Ⅰ期）疾病分别有2例和10例（p = 0.007）。18例患者（62%）因冠心病接受手术，10例患者（35%）因心脏瓣膜病接受手术。肾切除术分别在14例和5例患者中进行（p = 0.003），而部分肾切除术分别在1例和7例患者中进行（p = 0.005）。
两组的30天死亡率分别为13%（2例）和7%（1例），p = 1.0，主要医院并发症分别在3例（20%）和2例（14%）中观察到，p = 0.53。第1组和第2组的中位随访时间分别为87个月（范围23.3至146.8个月）和39个月（范围3.9至98个月），p = 0.001。三年总生存率分别为73.3±11.4%（95%CI 50.5 - 96.1）和77.9±11.3%，p = 0.70，三年无病生存率分别为83.9±10.4%和75.0±21.7%，p = 0.91。
肾肿瘤合并心脏病的同期手术和分期手术是可行的手术方式。肿瘤晚期且病程复杂的患者可从早期干预中获益，因此同期手术可能是他们的首选方案。对于局限性肾肿瘤，应采用分期手术。
