[Importance of embolization in the prognosis of cancer of the kidney].
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Biomedical subjects
Publications and source records attributed to W Leisering.
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A report is given on the therapy and prognosis of 38 patients with carcinoma of the penis. Prognosis depends on the extent and histological structure of the tumours. For small tumours (T1N0M0) methods of operation which conserve the organ (circumcision, extirpation of the tumour) combined with cryosurgical procedures have proved to be sufficient. However, most cases (T2 and T3 tumours) require amputation 1.5 to 2 cm into the healthy tissue. If lymph nodes are palpable, regional lymphadenectomy must be performed. Points of view vary on postoperative irradiation; we have only used it in cases of metastasis involving the inguinal lymph nodes. The 5-year survival rate of all patients is 68%, whereby no patient with a T1 tumour has died - on the other hand all those with T4 tumours died!
A report is given on the rate of complication in connection with 139 operations with incision of the renal parenchyma (= 29.3% of all operations to remove calculi). The number of early complications (urinary fistulas, secondary healing, vestigial calculi) is the same after polar resection and pyelocalicotomy as after pyelotomy, but is significantly greater after nephrectomy. The importance of temporary drainage of urine after nephrotomy and especially after operations in the stage of anuria is pointed out. The rate of complication for the various operations lies between 18.7 and 50%.
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In casuistic form if reported reported on 3 patients with a malignoma of the scrotum. Problems of etiology and therapy are discussed with the help of informations from literature and are compared with the own experiences. The radical operation far in the healthy region is regarded as necessary, but it has its restriction by often far progressed stages of the tumorous disease.
Embolization of renal tumors is receiving importance. This method of interventional radiology was modified for our conditions and completed by special nuclear medical diagnostic. 86 embolization procedures were carried out in 80 patients with richly vascularized renal tumours. Nephrectomy was performed in 66 of these cases. Efficacy of our embolization technique was evaluated by nuclear medicine, intraoperative morphological findings and histological results. There were no complications in our series. We have found only in one patient a rejection of isotope labelled embolic material into peripheral arteries without clinical consequence.
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Though cancer of the prostate is generally regarded as a fairly benign tumour with long survival, many patients die of it. The sovereignty of hormone therapy seems questionable in the light of recent experience. A selected patient material with early stage cancer of the prostate--incidental findings at the Freyer-Hryntschak operation for bladder neck adenoma--is presented for the illustration of the prognostic aspects of this tumour. Androgen control therapy was given postoperatively to every patient.
In 24 patients with malignant kidney tumours percutaneous embolizations of the arteria renalis were performed in about 1 year. The material for embolization was gelatine-sponge-particles. The embolization was done pre-operatively, usually in connection with the arteriographic examination of kidney tumours (hypernephroid carcinoma). In 2 patients without operation it was done as a palliative measure. Our favourable results to improve the operability of tumours agree with reports in the literature. According to our opinion the pre-operative embolization of the arteria renalis with kidney tumours offers the possibility of a blood-sparing operation and a reduction of tumour-cell outwashings.
It is reported on clinical and therapeutic measures in tumours of the upper urinary tracts. Diagnosis is often made too late, which, as we know, conditions a bad prognosis. Since we found malignant recidivations in papillomas and a stump recidivation in the carcinoma of the renal pelvis also in exclusive nephrectomy, we recommend the nephro-ureterectomy as a therapeutic measure.
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The retroperitoneal xanthofibrogranuloma is a rare disease with still unclear etiology. The clinical symptoms are uncharacteristic and in connection with laboratory-chemical and radiological findings let us first think of a malignoma. According to our opinion the therapy of choice is the radical as possible removal of the xanthofibrogranuloma, which is in most cases only possible with simultaneous nephrectomy. A superradicality is not necessary. The prognosis is good.
The majority of our cases (n = 107) were contusions of the kidneys, they were treated conservatively. If a rupture is to be expected the diagnostic measures should include infusion-urogram and selective arteriography. If a rupture has been proved, the early operation should follow immediately in order to preserve the organ. Treating ruptures of the kidneys conservatively should be an exception.
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With the help of observations the author adopts a definite attitude to the problem of recidivations, the residual adenomas, the calculi and the carcinomatous development ("pseudorecidivations") after the enucleation of adenomas of the vesical cervix. The cases in question are often carcinomas or parts of adenomas left in the primary operation. But real recidivations are also possible -- examples are alleged and theoretically proved, too.
In the dispensary consulting hours we are relatively often confronted with the relapsing lithiasis and the presence of only one kidney. The number of relapsing calculi repeatedly operated in residual kidneys is, however, not large and arises special problems. It is reported on 29 patients in whom we had to perform altogether 64 operations on the residual kidney--among them up to 8 operations on one kidney. Indication to operation, metaphylaxis and prognosis are explained on own cases.