Les K A, Nicholas R W, Rougraff B, Wurtz D, Vogelzang N J, Simon M A, Peabody T D
William Beaumont Hospital, Rose Cancer Center, Royal Oak, MI, USA.
Clin Orthop Relat Res. 2001 Sep(390):206-11. doi: 10.1097/00003086-200109000-00023.
The cases of 78 patients with osseous metastases from kidney cancer were reviewed to determine the rate of local progression after operative resection as compared with more traditional intralesional procedures. Group I consisted of 41 (53%) patients who were treated with intralesional procedures involving internal fixation with or without curettage or polymethylmethacrylate. Of the 41 patients, additional operations were recommended for 17 (41%) of the patients who had local osseous progression. Fourteen additional procedures including nine wide resections with reconstruction, three amputations, and two mass excisions were done. Group II consisted of 37 (47%) patients who were treated with marginal or wide resection with or without reconstruction. In this group, only one patient required additional operative intervention for local osseous progression. Median survival of patients in Group I was 20 months compared with 35 months for patients in Group IL This study shows that despite shorter average survival, patients who undergo intralesional surgery are at high risk of reoperation for local progression. Resectional surgery should be considered in patients with skeletal metastases from kidney cancer to lessen the risk of reoperation for local progression.
回顾了78例肾癌骨转移患者的病例，以确定与更传统的病灶内手术相比，手术切除后局部进展的发生率。第一组由41例（53%）患者组成，他们接受了病灶内手术，包括有或无刮除术或聚甲基丙烯酸甲酯的内固定。在这41例患者中，17例（41%）出现局部骨进展的患者被建议进行额外手术。进行了14次额外手术，包括9次广泛切除并重建、3次截肢和2次肿块切除。第二组由37例（47%）患者组成，他们接受了边缘或广泛切除，有或无重建。在该组中，只有1例患者因局部骨进展需要额外的手术干预。第一组患者的中位生存期为20个月，而第二组患者为35个月。这项研究表明，尽管平均生存期较短，但接受病灶内手术的患者因局部进展而再次手术的风险很高。对于肾癌骨转移患者，应考虑行切除性手术，以降低因局部进展而再次手术的风险。
