Ghavamian R, Zincke H
Department of Urology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
Semin Urol Oncol. 2001 May;19(2):103-13.
The goals of conservative resection of renal cell carcinoma are complete local surgical removal of the malignancy and preservation of adequate renal function. This is a delicate balance, which makes renal preserving surgery at times both challenging and controversial. Surgical management of renal cell carcinoma remains the most effective curative management. The increased use of cross-sectional imaging has led to an increased detection of incidental renal cell carcinomas at an earlier stage. The indications of nephron-sparing surgery (NSS) have evolved in the past decade. Clinically, there are scenarios where nephron-sparing surgery is absolutely indicated. However, in the setting of a normal contralateral kidney, radical nephrectomy is still considered by many to be the treatment of choice for localized renal cell carcinoma. There is now growing evidence that in the correct patient, the use of NSS in the above-mentioned situation is justified. Very recent data indicate that NSS provides effective and equivalent oncologic treatment for most renal cell carcinomas especially those 4 cm or smaller. Refined surgical techniques and new studies regarding the earlier diagnosis and biology of renal cell carcinoma, true incidence of occult multifocality, and comparable morbidity with radical nephrectomy make NSS an attractive tool in the armamentarium of the urologic surgeon.
肾细胞癌保守性切除术的目标是通过手术完全局部切除恶性肿瘤并保留足够的肾功能。这是一种微妙的平衡，这使得保留肾手术有时既具有挑战性又存在争议。肾细胞癌的手术治疗仍然是最有效的根治性治疗方法。横断面成像技术的使用增加，导致早期偶然发现的肾细胞癌的检出率增加。在过去十年中，保留肾单位手术（NSS）的适应证不断演变。临床上，存在一些绝对需要进行保留肾单位手术的情况。然而，在对侧肾脏正常的情况下，许多人仍然认为根治性肾切除术是局限性肾细胞癌的首选治疗方法。现在越来越多的证据表明，在合适的患者中，在上述情况下使用保留肾单位手术是合理的。最近的数据表明，保留肾单位手术为大多数肾细胞癌，尤其是那些4厘米或更小的肾细胞癌，提供了有效且等效的肿瘤治疗。精细的手术技术以及关于肾细胞癌早期诊断和生物学、隐匿性多灶性的真实发病率以及与根治性肾切除术相当的发病率的新研究，使保留肾单位手术成为泌尿外科医生武器库中的一种有吸引力的工具。
