Nefrectomía parcial en Colombia: situación actual

Abstract

Introduction and objectivesPartial nephrectomy technique has made this increasingly position itself as an oncological surgery that results comparable to radical nephrectomy with the advantage of conserving nephrons which impacts long-term quality of life patients. We present the results of a survey of urologic Colombian population regarding partial nephrectomy as treatment of renal masses. Materials and methodsWe designed an online questionnarie with 21 questions about specific concepts on partial nephrectomy for renal masses, the survey was distributed to all members of the Colombian Society of Urology (SCU) and we collect survey responses from urologists and residents through internet portal.- ResultsWe obtain responses from 65 people, mostly in Bogota (44%) and Medellin (30%), with% in La Costa, Cali and other regions from 5%, 6% and 14% respectively. 54 (86%) were urologists and 9 (14%) resident,mostly 3 and 4 year 56% and 44% respectively. Most urologists who answered the survey were mostly over 16 years of graduates (37%), 20% between 11 and 15 years, 22% between 5 and 10 years, 17% between 2 and 4 years and 4% one year or less. In 38% of respondents (n = 24/65) were between 40 and 50 years, 23% (n = 37/65) between 30 and 40 years, 13% (n = 8/65) between 50 and 60 years, 8% (n = 5/65) aged 60 years and 5% (n = 3/65) between 20 and 30.77% (n = 48/65) work in IV level of complexity, 19% (n = 12/65) at level 3, 3% (n = 2/65) at level 2 and none do it in low complexity centers. These are university centers in 73% (n = 46/65) of cases. The 35% (n = 22/65) of respondents made between 5–15 radical nephrectomy specimens per year, 34% (21/65) make less than 5, 26% (n = 16/54) between 15 and 25 and only 5% (n = 3/65) over 25 radical nephrectomies year. In the case of a patient candidate for partial nephrectomy, 81% of respondents proced to do it and in a partial nephrectomy with high difficulty, respondents in 80% (n = 48/65) will perform a open partial nephrectomy and the remaining 20% offers a laparoscopic radical nephrectomy. The vast majority of respondents do partial nephrectomy as part of treatment of renal masses (84%), and 57% make between 2–5 per year, 17% between 6–10, 13% only once a year, 9% between 11 to 20, 2% between 21–30 and 2% over 31 year. Most respondents perform elective partial nephrectomy (if normal contralateral kidney) 98%. The limit of size for renal masses in partial nephrectomy is 4–7 cm for 50% of responders, 0–4 cm for 41% and more than 7 cm for the remaining 9%. The vast majority use the open approach (71%), 9% make up 20% laparoscopic surgical approaches used both in clinical practice. The 65% of participants do not use any score to determine the degree of difficulty of partial nephrectomy and only 35% do it, where the most used the RENAL score scale and PADUA score and RUDA in 55%, 30% and 15% respectively. With respect to the renal vascular pedicle clamping, 51% define ischemia as appropriate, 18% always used warm ischemia, 16% always used cold ischemia and 15% do not use any type of ischemia. 92% believe that if after predicting potential ischemia time this is over 20 minutes is important to use cold ischemia and 57% of participants thinks that the planned ischemia time affects the selected approach and 43% think that the ischemic time does not influence the approach selected. ConclusionsThis online survey shows that despite performing a high volume annually radical nephrectomy , also partial nephrectomy is performed by a high percentage of urologists in the country when it has clear indications, this allows adequate preservation of nephrons and allow to improve the quality of life of patients.© 2014 Sociedad Colombiana de Urología. Published by Elsevier España, S.L. All rights reserved.