Denzinger Stefan, Ganzer Roman, Fink Andreas, Wieland Wolf F, Blana Andreas
Department of Urology, University of Regensburg, Krankenhaus St Josef, Regensburg, Germany.
Scand J Urol Nephrol. 2007;41(6):496-500. doi: 10.1080/00365590701485970.
To report the outcome of nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) with elective and imperative indications, with analysis of complications, renal function and long-term oncological follow-up.
We analyzed 91 patients undergoing NSS for RCC, 26 with imperative and 65 with elective indications. Variables analyzed included patient age and gender, comorbidities per patient and preoperative renal function. Pathological features included tumor size, WHO 2002 stage and grade. Peri- and postoperative data included complication and re-intervention rates, tumor recurrence and the mortality rate.
RCC was found in 81.3% of cases in the imperative group and in 73.9% in the elective group. Median tumor size was 3.2 and 2.5 cm (p = 0.02) in the imperative and elective groups, respectively. Operation time was longer in the imperative group (p < 0.01). There was no difference between the two groups regarding intraoperative complication rate (p = 0.37), whereas postoperative complications occurred more frequently in the imperative group (p = 0.02). The median follow-up period was 48 months for both groups. Mean serum creatinine during follow-up was significantly higher in the imperative group (238.4 vs 97.2 Micromol/L). However, no patient required hemodialysis. There was no local recurrence or tumor-specific death in either group.
NSS for RCC is a reasonable treatment option for patients with an imperative indication as it prevents the need for hemodialysis as well as ensuring excellent oncological follow-up. A higher postoperative complication rate has to be balanced against improved quality of life.
报告保留肾单位手术（NSS）治疗有择期和紧急指征的肾细胞癌（RCC）的结果，并分析并发症、肾功能及长期肿瘤学随访情况。
我们分析了91例行NSS治疗RCC的患者，其中26例有紧急指征，65例有择期指征。分析的变量包括患者年龄、性别、每位患者的合并症及术前肾功能。病理特征包括肿瘤大小、2002年世界卫生组织分期及分级。围手术期和术后数据包括并发症和再次干预率、肿瘤复发及死亡率。
紧急指征组81.3%的病例发现有RCC，择期指征组为73.9%。紧急指征组和择期指征组的肿瘤中位大小分别为3.2 cm和2.5 cm（p = 0.02）。紧急指征组的手术时间更长（p < 0.01）。两组术中并发症发生率无差异（p = 0.37），而紧急指征组术后并发症更常见（p = 0.02）。两组的中位随访期均为48个月。随访期间紧急指征组的平均血清肌酐显著更高（238.4 vs 97.2 μmol/L）。然而，没有患者需要血液透析。两组均无局部复发或肿瘤特异性死亡。
对于有紧急指征的患者，NSS治疗RCC是一种合理的治疗选择，因为它可避免血液透析的需要，并确保良好的肿瘤学随访。术后较高的并发症发生率必须与改善的生活质量相权衡。
