Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press56910.17650/2686-9594-2022-12-4-26-32ORIGINAL REPORTОРИГИНАЛЬНОЕ ИССЛЕДОВАНИЕPrediction factors in surgical treatment of intragrawn kidney cancer metastasisФакторы прогноза в хирургическом лечении внутригрудных метастазов рака почкиAkhmedovB. B.АхмедовБ. Б.
Russian Federation

Bahrom Bakhtierovich Akhmedov

115478, Moscow, Kashirskoe Shosse, 24

Бахром Бахтиерович Ахмедов

115478 Москва, Каширское шоссе, 24

abb_onc@mail.ruN.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России2012202212426322012202220122022Copyright ©; 2022, Akhmedov B.B.Copyright ©; 2022, Ахмедов Б.Б.2022Akhmedov B.B.Ахмедов Б.Б.https://creativecommons.org/licenses/by/4.0https://onco-surgery.info/jour/article/view/569

Background. The incidence of distant metastases of intrathoracic localization in kidney cancer, including intrathoracic lymph nodes, makes the problem of identifying and introducing knowledge about prognostic factors into clinical practice when using the surgical treatment of this disease urgent.Aim. To identify prognostic factors in the surgical treatment of intrathoracic metastases of renal cancer.Materials and methods. In this work, a retrospective analysis was carried out of a group of 100 patients with intrathoracic cancer metastases, almost who underwent surgical treatment in the form of removal of distant metastases. We analyzed the clinically significant factors associated with the prevalence of the tumor process in the lungs, which could affect the long-term results of treatment, as well as the influence of various instrumental research methods on the frequency of detection of intrathoracic lesions. In addition, the influence of the choice of surgical approach and the volume of surgery on the long-term survival of this group of patients was analyzed.Results. 40 (40 %) patients had synchronous and 60 (60 %) had metachronous lung metastases. 63 (63 %) had open and 36 (36 %) – thoracoscopic surgery, 1 (1 %) patient underwent a transdiaphragmatic resection. 70 (70 %) patients had atypical lung resections. 5-year overall survival was 53.4 %, 5-year progression-free survival – 43.1 %. There was no postoperative mortality and no grade 3–4 morbidity. Following factors were associated with an overall survival during a single-factor analysis: bilateral lung lesions (р <0.0001), R0 resection (р = 0.002), Munich scale (р = 0.007). Only bilateral lung lesion were associated with an overall survival during a multifactor analysis (р = 0.001).Conclusions. Removal of intrathoracic metastases of kidney cancer in the lung can lead to long-term survival in a significant number of patients. Achieving R0 resection is the main goal of surgical treatment.

Введение. Частота развития метастазов внутригрудной локализации при раке почки делает актуальной задачу выявления факторов прогноза хирургического лечения данного заболевания и внедрения этих знаний в клиническую практику.Цель исследования – выявить факторы прогноза при хирургическом лечении внутригрудных метастазов рака почки.Материалы и методы. В работе был проведен ретроспективный анализ историй болезни 100 пациентов с внутригрудными метастазами рака почки, перенесших хирургическое лечение по поводу удаления этих метастазов. Были проанализированы клинически значимые факторы, связанные с распространенностью опухолевого процесса в легких, которые могут влиять на отдаленные результаты лечения, а также исследована частота выявления внутригрудных поражений различными инструментальными методами диагностики. Помимо этого было проанализировано влияние хирургического доступа и объема операции на выживаемость данной группы пациентов.Результаты. У 40 (40 %) пациентов имелись синхронные метастазы в легких, у 60 (60 %) – метахронные. У 63 % пациентов операции были выполнены из торакотомного доступа, у 36 (36 %) – из торакоскопического, у 1 (1 %) – из трансдиафрагмального. У 70 (70 %) больных выполнены атипичные резекции легкого. Пятилетняя общая выживаемость составила 53,4 %, 5-летняя выживаемость без прогрессирования – 43,1 %. Послеоперационной летальности и осложнений III–IV степени не отмечено. При однофакторном анализе на общую выживаемость влияли наличие одно- или двустороннего поражения (р <0,0001), радикальность операции (р = 0,002), прогностическая группа по шкале Munich (р = 0,007). При многофакторном анализе – только наличие двустороннего поражения легких (р = 0,001).Выводы. Удаление внутригрудных метастазов рака почки может привести к долгосрочной выживаемости у значительного числа пациентов. Основной задачей хирурга должно быть выполнение резекции в объеме R0.

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