Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
J Urol. 2010 Feb;183(2):473-9. doi: 10.1016/j.juro.2009.10.023. Epub 2009 Dec 14.
Open partial nephrectomy has proven long-term oncological efficacy. Long-term outcomes of laparoscopic partial nephrectomy are pending. We present the long-term outcomes of patients undergoing laparoscopic or open partial nephrectomy for a single cT1 renal cortical tumor 7 cm or less.
Of 2,246 patients undergoing partial nephrectomy for a single cT1 tumor (1999 to 2008), minimum 7-year followup was available in 77 and 310, and minimum 1-year followup was available in 672 and 944 after laparoscopic and open partial nephrectomy, respectively. Survival and recurrence data obtained from medical records, radiographic reports and patient contact were analyzed retrospectively.
Median followup after laparoscopic and open partial nephrectomy was 4.0 and 5.7 years, respectively. Oncological outcomes were excellent in both groups. On multivariable analysis predictors of all cause mortality included advancing age (p <0.0001), comorbidity (p <0.0001) and preoperative renal dysfunction (p = 0.0001) but not tumor size (p = 0.6) or operative approach (laparoscopic vs open partial nephrectomy, p = 0.06). Cancer recurred infrequently and only rarely caused mortality after laparoscopic or open partial nephrectomy. At 7 years metastasis-free survival was 97.5% and 97.3% (p = 0.47) after laparoscopic and open partial nephrectomy, respectively. After accounting for baseline differences between the cohorts using propensity score matching 7-year metastasis-free survival was similar after laparoscopic and open partial nephrectomy.
Laparoscopic and open partial nephrectomy appear to provide similar long-term overall and cancer specific survival in patients undergoing partial nephrectomy for clinical stage T1 (7 cm or less) renal cortical tumors. Oncological outcomes at 7 years after laparoscopic and open partial nephrectomy are excellent with the majority (97%) of patients experiencing metastasis-free survival.
开放性部分肾切除术已被证实具有长期的肿瘤学疗效。腹腔镜部分肾切除术的长期结果仍有待观察。我们报告了 7cm 或更小的单个 cT1 肾皮质肿瘤接受腹腔镜或开放性部分肾切除术的患者的长期结果。
在 2246 例接受单个 cT1 肿瘤部分肾切除术的患者中（1999 年至 2008 年），腹腔镜和开放性部分肾切除术分别有 77 例和 310 例获得了至少 7 年的随访，有 672 例和 944 例获得了至少 1 年的随访。通过病历、影像学报告和患者联系获得生存和复发数据，并进行回顾性分析。
腹腔镜和开放性部分肾切除术的中位随访时间分别为 4.0 年和 5.7 年。两组的肿瘤学结果均优异。多变量分析显示，全因死亡率的预测因素包括年龄增长（p<0.0001）、合并症（p<0.0001）和术前肾功能不全（p=0.0001），而不是肿瘤大小（p=0.6）或手术方式（腹腔镜与开放性部分肾切除术，p=0.06）。腹腔镜或开放性部分肾切除术后癌症复发罕见，且仅极少数导致死亡。7 年无转移生存率分别为 97.5%和 97.3%（p=0.47）。在使用倾向评分匹配消除队列之间的基线差异后，腹腔镜和开放性部分肾切除术的 7 年无转移生存率相似。
对于临床分期 T1（7cm 或更小）肾皮质肿瘤的患者，腹腔镜和开放性部分肾切除术似乎提供了相似的长期总体和癌症特异性生存。腹腔镜和开放性部分肾切除术后 7 年的肿瘤学结果优异，大多数（97%）患者无转移生存。
