Delakas Dimitrios, Karyotis Ioannis, Daskalopoulos George, Terhorst Bodo, Lymberopoulos Stavros, Cranidis Angelos
Department of Urology, General University Hospital of Heraklion, Crete, Greece.
Urology. 2002 Dec;60(6):998-1002. doi: 10.1016/s0090-4295(02)01993-3.
To assess the long-term effectiveness and safety of nephron-sparing surgery for the treatment of localized renal cell carcinoma with a normal contralateral kidney.
Since 1973, 118 patients have undergone nephron-sparing surgery for renal cell carcinoma on an elective basis at our institutions. The vast majority of these tumors were incidental findings, with a mean tumor diameter of 3.35 cm (range 0.7 to 5.6). The median follow-up was 8.5 years (range 0.5 to 18), and of those patients alive, 27 (28%) were followed up for more than 10 years.
The pathologic stage was pT1N0M0 in 110 cases (93.2%) and pT3aN0M0 in 8 (6.7%); 59 were grade 1, 52 were grade 2, and 7 were grade 3. Complications occurred in 4 patients, including retroperitoneal bleeding in 1 treated by reoperation, urinomas in 2, and ureteral stricture in 1 treated conservatively. Renal function remained normal during the whole follow-up period, and slight proteinuria was observed in 13 patients. The 10-year distant and local recurrence rate was 4% and 3.9%, respectively. The cancer-specific 5, 10, and 15-year survival rate was 97.3%, 96.4%, and 96.4%, respectively.
Our experience, based on a long median follow-up, suggests that nephron-sparing surgery on an elective basis can achieve long-term survival for the treatment of incidental and low-stage renal cell carcinomas without compromising the efficacy of cancer treatment.
评估保留肾单位手术治疗对侧肾脏正常的局限性肾细胞癌的长期有效性和安全性。
自1973年以来，我们机构有118例患者因肾细胞癌接受了选择性保留肾单位手术。这些肿瘤绝大多数是偶然发现的，平均肿瘤直径为3.35厘米（范围0.7至5.6厘米）。中位随访时间为8.5年（范围0.5至18年），在存活的患者中，27例（28%）随访时间超过10年。
病理分期为pT1N0M0的有110例（93.2%），pT3aN0M0的有8例（6.7%）；1级59例，2级52例，3级7例。4例患者出现并发症，包括1例经再次手术治疗的腹膜后出血、2例尿囊肿和1例经保守治疗的输尿管狭窄。在整个随访期间肾功能保持正常，13例患者出现轻度蛋白尿。10年远处和局部复发率分别为4%和3.9%。癌症特异性5年、10年和15年生存率分别为97.3%、96.4%和96.4%。
基于长期的中位随访经验，我们认为选择性保留肾单位手术可使偶然发现的低分期肾细胞癌患者获得长期生存，且不影响癌症治疗效果。
