Chertin Boris, Benjamin Shalva, Reissman Pethachia, Kheifets Alexander, Prat Orly, Shenfeld Ofer Z, Sidi Ami A, Tsivian Alexander
Department of Urology, Shaare Zedek Medical Center, Affiliated with Hebrew University Jerusalem, Jerusalem, Israel.
Surg Laparosc Endosc Percutan Tech. 2009 Aug;19(4):353-5. doi: 10.1097/SLE.0b013e3181ac7e8d.
We aimed to evaluate our experience with the transperitoneal radical nephrectomy (TLRN) in patients with large (more than 7 cm) renal mass to determine if this procedure can be recommended as a reference standard for treating large renal masses.
Of 213 patients who underwent TLRN in both institutions we have reviewed medical files of 35 who had large than 7 cm renal masses. Operative time, blood loss, conversion rate, pathologic tumor type, and oncologic outcome were evaluated.
The mean tumor size was 10.1 cm (range: 7 to 19 cm). Mean blood loss during surgery was 388 mL (range: 150 to 600 mL). In 2 patients with 16 cm renal masses the operation was converted to hand-assisted technique as planned upon the surgery after ligation and transsection of the vascular pedicel to facilitate kidney dissection from surrounding tissue. In 1 patient the operation was converted to the open technique. Twenty-two (62.8%) patients had renal cell carcinoma and the remaining 13(37.5%) patients had other types of the renal tumors. Mean hospital stay was 4.36 days (range: 3 to 7 d). Median follow-up after the surgery was 29 months (range: 8 to 60 mo). Three patients who underwent cytoreduction nephrectomy died whereas receiving immunotherapy 3, 8, and 11 months, respectively, after surgery. One patient developed a local tumor recurrence and 2 developed remote metastasizes.
Our data show that TLRN is an effective procedure for the removal larger than 7 cm renal tumors. In those patients with exceptionally big tumors planned conversion to the hand-assisted technique after laparoscopic ligation of the renal vessels enabling easier renal dissection whereas preserving the advantages of minimally invasive procedure.
我们旨在评估经腹腔根治性肾切除术（TLRN）治疗大体积（超过7厘米）肾肿物患者的经验，以确定该手术是否可被推荐为治疗大体积肾肿物的参考标准。
在两家机构接受TLRN手术的213例患者中，我们回顾了35例肾肿物大于7厘米患者的病历。评估了手术时间、失血量、中转率、病理肿瘤类型和肿瘤学结局。
肿瘤平均大小为10.1厘米（范围：7至19厘米）。手术期间平均失血量为388毫升（范围：150至600毫升）。2例肾肿物为16厘米的患者，在结扎和横断血管蒂后，按计划在手术中转为手辅助技术，以便于从周围组织中分离肾脏。1例患者转为开放手术。22例（62.8%）患者患有肾细胞癌，其余13例（37.5%）患者患有其他类型的肾肿瘤。平均住院时间为4.36天（范围：3至7天）。术后中位随访时间为29个月（范围：8至60个月）。3例行减瘤性肾切除术的患者分别在术后3、8和11个月接受免疫治疗时死亡。1例患者出现局部肿瘤复发，2例出现远处转移。
我们的数据表明，TLRN是切除大于7厘米肾肿瘤的有效手术。对于那些肿瘤特别大的患者，计划在腹腔镜结扎肾血管后转为手辅助技术，以便更轻松地进行肾脏分离，同时保留微创手术的优势。
