Lifshitz David A, Shikanov Sergey A, Deklaj Tom, Katz Mark H, Zorn Kevin C, Shalhav Arieh L
Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA.
J Endourol. 2010 Jan;24(1):49-55. doi: 10.1089/end.2009.0348.
To compare the perioperative and functional outcomes of patients with clinical T(1a) and T(1b) renal tumors after laparoscopic partial nephrectomy (LPN).
Data of 184 patients who underwent LPN were retrieved from a prospective, Institutional Review Board-approved database. The patients were stratified for analysis into groups: 149 (81%) patients with clinical stage T(1a) (group 1) and 35 (19%) patients with clinical stage T(1b) (group 2). Perioperative and postoperative outcomes were compared.
No significant differences between groups 1 and 2 in warm ischemia time, estimated blood loss, operative time, conversion rate, intraoperative complication rate, and hospital stay were observed. The incidence of postoperative complications in group 2, however, was twice that of group 1 (25.7% vs 12%) (P = 0.04). Clinical staging correlated with the pathologic staging in 96% of the patients in group 1 and in only 71% in group 2 (P < 0.001). Upstaging to pT(2) or pT(3) occurred in 29% of the patients in group 2. High-grade tumors were more prevalent in group 2 (36% vs 12%) (P = 0.001). The number of patients with positive margin was higher in group 2, but the difference was not statistically significant. The mean decline in estimated creatinine clearance (median follow-up 18 months) was significantly higher in group 2.
LPN in patients with tumors >4 cm, while safe and feasible in experienced hands, is associated with a higher postoperative complication rate, as well as a higher rate of pathologic upstaging. Such data should be discussed when counseling patients with larger tumors for LPN.
比较临床T(1a)和T(1b)期肾肿瘤患者行腹腔镜肾部分切除术（LPN）后的围手术期及功能结局。
从一个前瞻性、经机构审查委员会批准的数据库中检索184例行LPN患者的数据。将患者分层分析为两组：149例（81%）临床分期为T(1a)期的患者（第1组）和35例（19%）临床分期为T(1b)期的患者（第2组）。比较围手术期和术后结局。
第1组和第2组在热缺血时间、估计失血量、手术时间、中转率、术中并发症发生率和住院时间方面未观察到显著差异。然而，第2组术后并发症发生率是第1组的两倍（25.7%对12%）（P = 0.04）。第1组96%的患者临床分期与病理分期相关，而第2组仅71%相关（P < 0.001）。第2组29%的患者病理分期升为pT(2)或pT(3)。高级别肿瘤在第2组更常见（36%对12%）（P = 0.001）。第2组切缘阳性患者数量较多，但差异无统计学意义。第2组估计肌酐清除率的平均下降幅度（中位随访18个月）显著更高。
对于肿瘤>4 cm的患者，LPN在经验丰富的医生手中虽然安全可行，但术后并发症发生率较高，且病理分期升级率也较高。在为较大肿瘤患者提供LPN咨询时，应讨论这些数据。
