Moinzadeh Alireza, Gill Inderbir S, Finelli Antonio, Kaouk Jihad, Desai Mihir
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute and Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2006 Feb;175(2):459-62. doi: 10.1016/S0022-5347(05)00147-3.
LPN is a viable alternative to open partial nephrectomy for select small renal tumors. However, published intermediate term oncological data are sparse. We present our experience with LPN for tumor in 100 patients with a minimum followup of 3 years.
Of the 480 LPNs performed at our institution a minimum followup of 3 years is available in 100 patients since 1999. Overall and cancer specific survival data were obtained from patient charts, radiographic reports and direct telephone calls to patient families.
All 100 cases were completed laparoscopically without open conversion. Mean tumor size was 3.1 cm and mean warm ischemia was 27 minutes. Final histopathology revealed renal cell carcinoma in 68 patients, including 1 with positive surgical margins. A second patient with oncocytoma had a positive surgical margin. At a median followup of 42 months (mean 42.6, range 24.3 to 62.5) no patient had evidence of local or port site recurrence. Two patients with renal cell carcinoma had a contralateral renal mass. Overall survival was 86% and cancer specific survival was 100%. Mean preoperative and postoperative serum creatinine was 1.1 and 1.3 mg/dl, respectively. Two patients with preoperative chronic renal insufficiency were undergoing hemodialysis.
At 3-year followup LPN provides oncological outcomes comparable to those in contemporary open partial nephrectomy series.
对于某些小肾肿瘤，腹腔镜下肾部分切除术（LPN）是开放性肾部分切除术的一种可行替代方法。然而，已发表的中期肿瘤学数据较少。我们介绍了我们对100例患者行LPN治疗肿瘤的经验，这些患者的最短随访时间为3年。
自1999年以来，我们机构共进行了480例LPN，其中100例患者有至少3年的随访资料。通过患者病历、影像学报告以及直接致电患者家属获取总体生存和癌症特异性生存数据。
所有100例手术均通过腹腔镜完成，无中转开放手术。肿瘤平均大小为3.1 cm，平均热缺血时间为27分钟。最终组织病理学检查显示，68例患者为肾细胞癌，其中1例手术切缘阳性。另1例嗜酸细胞瘤患者手术切缘阳性。在中位随访42个月（平均42.6个月，范围24.3至62.5个月）时，无患者出现局部或切口部位复发迹象。2例肾细胞癌患者对侧肾脏有肿物。总体生存率为86%，癌症特异性生存率为100%。术前和术后血清肌酐平均分别为1.1和1.3 mg/dl。2例术前慢性肾功能不全患者正在接受血液透析。
在3年随访时，LPN的肿瘤学结果与当代开放性肾部分切除术系列相当。
