Kaouk Jihad H, Gill Inderbir S
Rev Urol. 2002 Winter;4(1):38-42.
At specialized centers worldwide, laparoscopic radical nephrectomy is now routine practice for management of indicated patients with localized renal cell carcinoma. Although the various intraoperative technical steps and maneuvers have been standardized for both the retroperitoneal and the transperitoneal laparoscopic approaches, controversy persists regarding the method of extraction of the nephrectomized cancerous specimen. Opinion is divided between intact extraction and morcellation. Clearly, the larger skin incision used for intact extraction is a cosmetic compromise. However, available data suggest that patient morbidity is not adversely impacted to any significant degree. Intact specimen extraction does build confidence into this procedure by respecting scientifically established oncologic guidelines, and it provides a specimen identical to that obtained in open surgery. This facilitates accurate pathologic staging, including assessment of surgical margins, which allows formulation of individualized, patient-specific follow-up protocols. For these reasons, intact extraction for renal cell cancer is preferred at our institution and multiple others worldwide.
在全球各地的专业中心，腹腔镜根治性肾切除术现已成为治疗特定局限性肾细胞癌患者的常规做法。尽管腹膜后和经腹腹腔镜手术的各种术中技术步骤和操作已实现标准化，但对于切除的癌性标本的取出方法仍存在争议。意见主要分为完整取出和切碎取出两种。显然，用于完整取出的较大皮肤切口在美观方面有所妥协。然而，现有数据表明，患者的发病率并未受到任何显著的不利影响。通过遵循科学确立的肿瘤学指南，完整标本取出确实为该手术增强了信心，并且它提供了与开放手术中获得的标本相同的标本。这有助于进行准确的病理分期，包括评估手术切缘，从而能够制定个性化的、针对患者的随访方案。出于这些原因，我们机构以及全球其他多个机构更倾向于对肾细胞癌进行完整取出。
