Berger Aaron D, Kanofsky Jamie A, O'Malley Rebecca L, Hyams Elias S, Chang Carolyn, Taneja Samir S, Stifelman Michael D
Department of Urology, New York University School of Medicine, New York, New York 10016, USA.
Urology. 2008 Mar;71(3):421-4. doi: 10.1016/j.urology.2007.10.057.
To evaluate our laparoscopic radical nephrectomy (LRN) series to determine whether any significant increases have occurred in operative morbidity when resecting large (7 cm or greater) renal masses. LRN is becoming the reference standard for treating suspicious renal masses not amenable to nephron-sparing surgery.
We retrospectively reviewed the charts of 164 consecutive patients who had undergone laparoscopic radical nephrectomy performed for suspicious renal masses by two surgeons from February 2000 and December 2006. After institutional review board approval, we reviewed the patient charts to determine whether patients with 7-cm or larger lesions had significant differences in age, body mass index, American Society of Anesthesiologists class, operative time, estimated blood loss, conversion rate, positive margin rate, postoperative creatinine, and hematocrit compared with patients with lesions smaller than 7 cm.
The data from 164 patients were reviewed. Of these 164 patients, 124 had less than 7-cm masses and 40 had lesions 7 cm or larger. The mean tumor size in the less than 7-cm group was 4.2 cm (range 1.8 to 6.9) and was 9.2 cm (range 7 to 14) in the 7-cm or larger group. The patients with large tumors had a significantly longer operative time, greater estimated blood loss, and increase in postoperative serum creatinine than those with smaller tumors but all other perioperative variables were similar. Two conversions to open radical nephrectomy occurred in both groups.
Our data have clearly shown that larger tumors can safely be resected with transperitoneal laparoscopic nephrectomy. Open nephrectomy for large tumors can be associated with increased morbidity and the use of LRN could minimize this increased risk. Urologists with laparoscopic experience should consider expanding their indication for LRN.
评估我们的腹腔镜根治性肾切除术（LRN）系列病例，以确定切除大的（7厘米或更大）肾肿块时手术并发症是否有显著增加。LRN正成为治疗不适于保留肾单位手术的可疑肾肿块的参考标准。
我们回顾性分析了2000年2月至2006年12月期间由两位外科医生为可疑肾肿块行腹腔镜根治性肾切除术的164例连续患者的病历。经机构审查委员会批准后，我们查阅患者病历，以确定与小于7厘米肿块的患者相比，7厘米或更大肿块的患者在年龄、体重指数、美国麻醉医师协会分级、手术时间、估计失血量、中转率、切缘阳性率、术后肌酐和血细胞比容方面是否存在显著差异。
对164例患者的数据进行了回顾。在这164例患者中，124例肿块小于7厘米，40例肿块为7厘米或更大。小于7厘米组的平均肿瘤大小为4.2厘米（范围1.8至6.9厘米），7厘米或更大组为9.2厘米（范围7至14厘米）。大肿瘤患者的手术时间明显更长，估计失血量更大，术后血清肌酐升高，但其所有其他围手术期变量相似。两组均有2例中转至开放性根治性肾切除术。
我们的数据清楚地表明，经腹腔腹腔镜肾切除术能够安全地切除较大肿瘤。开放性肾切除术治疗大肿瘤可能会增加并发症，而使用LRN可以将这种增加的风险降至最低。有腹腔镜经验的泌尿外科医生应考虑扩大其LRN的适应证。
