Rosoff James S, Raman Jay D, Sosa R Ernest, Del Pizzo Joseph J
Department of Urology, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10065, USA.
JSLS. 2009 Apr-Jun;13(2):148-53.
To report our operative experience and oncologic outcomes for the laparoscopic management of large renal tumors.
All laparoscopic and hand-assisted laparoscopic radical nephrectomies performed at our institution were reviewed. Thirty patients with tumors >or=7cm and a pathologic diagnosis of renal cell carcinoma were included.
Mean operative time was 175.7+/-24.5 minutes, and mean estimated blood loss was 275.5+/-165.8 mL. No case required conversion to open radical nephrectomy. The mean hospital stay was 2.4+/-1.6 days. Four patients (13%) had minor complications. Of the 30 tumors, 18 were pathologic stage T2, 9 were stage T3a, 2 were stage T3b, and one was stage T4. At a mean follow-up of 30 months (range, 10 to 70), 22 patients (73%) were alive without evidence of recurrence, and 5 patients (17%) were alive with disease. One patient (3%) died of complications related to renal cell carcinoma, and 2 patients (7%) died from other causes. Overall survival was 90%, cancer-specific survival was 97%, and recurrence-free survival was 80%.
Laparoscopic radical nephrectomy for large tumors is a technically challenging operation. However, in experienced hands, it is a reasonable therapeutic option for the management of larger RCC neoplasms.
报告我们对大型肾肿瘤进行腹腔镜治疗的手术经验和肿瘤学结果。
回顾了在我们机构进行的所有腹腔镜和手辅助腹腔镜根治性肾切除术。纳入了30例肿瘤直径≥7cm且病理诊断为肾细胞癌的患者。
平均手术时间为175.7±24.5分钟，平均估计失血量为275.5±165.8毫升。无病例需要转为开放性根治性肾切除术。平均住院时间为2.4±1.6天。4例患者（13%）出现轻微并发症。30个肿瘤中，18个为病理分期T2，9个为T3a期，2个为T3b期，1个为T4期。平均随访30个月（范围10至70个月），22例患者（73%）存活且无复发迹象，5例患者（17%）带瘤存活。1例患者（3%）死于与肾细胞癌相关的并发症，2例患者（7%）死于其他原因。总生存率为90%，癌症特异性生存率为97%，无复发生存率为80%。
腹腔镜根治性肾切除术治疗大型肿瘤是一项技术上具有挑战性的手术。然而，在经验丰富的医生手中，它是治疗较大肾细胞癌肿瘤的一种合理治疗选择。
