Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Eur Urol. 2010 Feb;57(2):214-22. doi: 10.1016/j.eururo.2009.10.019. Epub 2009 Oct 20.
The gained expertise in the surgical technique of partial nephrectomy (PN) with excellent oncologic outcome and reduced morbidity has contributed to more frequent use of PN in many centres of reference, and the recent evidence favouring PN over radical nephrectomy (RN) in the prevention of chronic kidney disease and possibly linking it to a better overall survival (OS) will constitute a strong argument for wider use of PN.
To objectively analyse the advantages of PN over RN and to evaluate the risk-benefit ratio of expanding the indications of PN T1b renal cortical tumours.
Literature searches on English-language publications were performed using the National Library of Medicine database. The queries included the keywords partial nephrectomy and nephron sparing surgery. Eight hundred four references were scrutinised, and 175 publications were identified and reviewed. Sixty-nine articles were selected for this review. These references formed the basis for this analysis and were selected based on their relevance and the importance of their content.
The use of PN has been steadily increasing, particularly in tertiary care centres. This trend is now strengthened by evidence supporting the role of PN in reducing the risk of chronic kidney disease in patients with renal masses < or =4 cm. A wider use of PN for larger tumours, granted technical feasibility, is supported by the preliminary evidence, suggesting an OS advantage favouring PN over RN. However, the potential for selection bias and residual confounding factors may contribute to the observed difference. In the carefully selected patients with tumours >4 cm, PN obtained equivalent oncologic outcome to that achieved after RN. Although higher morbidity rates were seen after PN, the complication type and severity were not prohibitive.
The available evidence supports elective PN as the standard surgical treatment for renal cortical tumours < or =4 cm. For larger tumours, PN has demonstrated feasibility and oncologic safety in the carefully selected patient population studied.
部分肾切除术（PN）的手术技术日益精湛，具有出色的肿瘤学结果和较低的发病率，这促使许多参考中心更频繁地使用 PN，而最近的证据表明 PN 在预防慢性肾脏病方面优于根治性肾切除术（RN），并可能与更好的总体生存率（OS）相关联，这将成为更广泛使用 PN 的有力论据。
客观分析 PN 相对于 RN 的优势，并评估扩大 PN T1b 肾皮质肿瘤适应证的风险效益比。
使用国家医学图书馆数据库对英文文献进行了文献检索。查询关键词包括部分肾切除术和保留肾单位手术。共筛选了 804 篇参考文献，并确定了 175 篇出版物进行了评估。选择了 69 篇文章进行了本次综述。这些参考文献构成了本次分析的基础，并根据其相关性和内容的重要性进行了选择。
PN 的使用一直在稳步增加，特别是在三级保健中心。这一趋势现在得到了支持，因为有证据表明 PN 在降低 4cm 以下肾肿块患者慢性肾脏病风险方面发挥作用。如果技术上可行，对更大肿瘤更广泛地使用 PN 得到了初步证据的支持，该证据表明 PN 在 OS 方面优于 RN。然而，选择偏倚和残留混杂因素的潜在影响可能导致观察到的差异。在精心挑选的肿瘤>4cm 的患者中，PN 获得的肿瘤学结果与 RN 相当。尽管 PN 后发病率较高，但并发症的类型和严重程度并无妨碍。
现有证据支持将选择性 PN 作为 4cm 以下肾皮质肿瘤的标准手术治疗方法。对于更大的肿瘤，PN 在精心挑选的研究人群中已证明了可行性和肿瘤学安全性。
