Rabets John C, Kaouk Jihad, Fergany Amr, Finelli Antonio, Gill Inderbir S, Novick Andrew C
Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Urology. 2004 Nov;64(5):930-4. doi: 10.1016/j.urology.2004.06.052.
To compare the outcomes of those patients who underwent laparoscopic versus open cytoreductive nephrectomy. Cytoreductive nephrectomy before systemic therapy has been shown to offer a survival advantage compared with systemic therapy alone for metastatic renal cell carcinoma.
We reviewed the outcomes of all patients who underwent either open or laparoscopic cytoreductive nephrectomy between 2000 and 2003. The inclusion criteria included patients with tumors 15 cm or less without local invasion, venous involvement, or bulky local adenopathy who had concurrent metastatic disease. A total of 64 patients (22 in the laparoscopic group and 42 in the open group) fulfilled these criteria. The parameters measured were age, tumor size, operative time, estimated blood loss, complications, length of hospital stay, percentage of patients receiving systemic therapy, and the interval to the start of systemic therapy. Kaplan-Meier survival estimates were compared.
Patients who underwent laparoscopic cytoreductive nephrectomy had a shorter length of stay (2.3 versus 6.1 days) and less operative blood loss (288 versus 1228 mL) than those who underwent open nephrectomy. Patients in the laparoscopic group received systemic therapy sooner after surgery (36 versus 61 days) than those in the open group. The Kaplan-Meier survival estimates were similar for both groups, with a 1-year survival rate of 61% in the laparoscopic group and 65% in the open group.
With judicious patient selection, laparoscopic cytoreductive nephrectomy can be performed safely, with minimal morbidity, and may shorten the interval from nephrectomy to the start of systemic therapy.
比较接受腹腔镜与开放性细胞减灭性肾切除术患者的治疗结果。对于转移性肾细胞癌，与单纯全身治疗相比，在全身治疗前进行细胞减灭性肾切除术已显示出具有生存优势。
我们回顾了2000年至2003年间接受开放性或腹腔镜细胞减灭性肾切除术的所有患者的治疗结果。纳入标准包括肿瘤直径15厘米及以下、无局部侵犯、无静脉受累或无巨大局部淋巴结病且伴有转移性疾病的患者。共有64例患者（腹腔镜组22例，开放组42例）符合这些标准。测量的参数包括年龄、肿瘤大小、手术时间、估计失血量、并发症、住院时间、接受全身治疗的患者百分比以及开始全身治疗的间隔时间。比较了Kaplan-Meier生存估计值。
接受腹腔镜细胞减灭性肾切除术的患者住院时间较短（2.3天对6.1天），手术失血量较少（288毫升对1228毫升）。腹腔镜组患者术后接受全身治疗的时间比开放组早（36天对61天）。两组的Kaplan-Meier生存估计值相似，腹腔镜组1年生存率为61%，开放组为65%。
经过审慎的患者选择，腹腔镜细胞减灭性肾切除术可以安全地进行，发病率最低，并且可能缩短从肾切除术到开始全身治疗的间隔时间。
