Lane Brian R, Gill Inderbir S
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2007 Jan;177(1):70-4; discussion 74. doi: 10.1016/j.juro.2006.08.093.
Laparoscopic partial nephrectomy is increasingly a definitive therapeutic option in patients with a small renal mass. Intermediate term oncological outcomes after laparoscopic partial nephrectomy are excellent up to a mean followup of 3 years. We present outcomes in 56 patients, each of whom has now completed a minimum of 5 years of followup after laparoscopic partial nephrectomy.
Of the 557 laparoscopic partial nephrectomies performed at our institution 58 patients with a localized tumor have completed more than 5 years since surgery. Clinical and renal functional data on 56 patients (97%) were obtained from medical records, radiographic reports and patient contact via telephone.
Average patient age was 64 years and 9% were symptomatic at presentation. Average tumor size was 2.9 cm. On histopathology renal cell carcinoma was confirmed in 37 cases (66%) and pathological tumor stage was pT1a in 32 (86%). Final surgical margin was positive for cancer in 1 patient. Median serum creatinine preoperatively and postoperatively was 0.9 and 1.0 mg/dl, respectively. No patient with normal baseline serum creatinine undergoing elective laparoscopic partial nephrectomy had postoperative chronic renal insufficiency (serum creatinine more than 2 mg/dl). At a median followup of 5.7 years (range 5.0 to 6.9) no distant recurrence (0%) and a single local recurrence (2.7%) were detected. Overall and cancer specific survival was 86% and 100%, respectively, at 5 years.
To our knowledge this is the initial report in the literature of oncological and renal functional outcomes 5 years after laparoscopic partial nephrectomy with excellent results comparable to those of open nephron sparing surgery. At our center laparoscopic partial nephrectomy is an established alternative to open partial nephrectomy.
腹腔镜下部分肾切除术越来越多地成为小肾肿瘤患者的确定性治疗选择。腹腔镜下部分肾切除术后的中期肿瘤学结局良好，平均随访时间达3年。我们报告了56例患者的结局，这些患者均已完成了至少5年的腹腔镜下部分肾切除术后随访。
在我们机构进行的557例腹腔镜下部分肾切除术中，58例局限性肿瘤患者术后已超过5年。通过病历、影像学报告以及电话联系患者，获取了56例患者（97%）的临床和肾功能数据。
患者平均年龄为64岁，9%的患者在就诊时有症状。肿瘤平均大小为2.9厘米。组织病理学检查确诊37例（66%）为肾细胞癌，32例（86%）的病理肿瘤分期为pT1a。1例患者的最终手术切缘癌呈阳性。术前和术后血清肌酐中位数分别为0.9和1.0毫克/分升。基线血清肌酐正常且接受择期腹腔镜下部分肾切除术的患者均未出现术后慢性肾功能不全（血清肌酐超过2毫克/分升）。中位随访时间为5.7年（范围5.0至6.9年），未检测到远处复发（0%），仅1例局部复发（2.7%）。5年时的总生存率和癌症特异性生存率分别为86%和100%。
据我们所知，这是文献中关于腹腔镜下部分肾切除术后5年肿瘤学和肾功能结局的首次报告，结果优异，与开放性保留肾单位手术相当。在我们中心，腹腔镜下部分肾切除术是开放性部分肾切除术的既定替代方案。
