Roos F C, Pahernik S, Brenner W, Thüroff J W
Department of Urology, Johannes Gutenberg-University, Medical School, Mainz, Germany.
Aktuelle Urol. 2010 Jan;41 Suppl 1:S70-6. doi: 10.1055/s-0029-1224649. Epub 2010 Jan 21.
Nephron-sparing surgery (NSS) is mandatory for patients with renal tumors in both kidneys or in a solitary kidney in order to preserve renal function (imperative indication). NSS has also become the gold standard (elective indication) for small unilateral renal tumors (< 4 cm) with a normal contralateral kidney. We report the oncological long-term follow-up of NSS of our own series and discuss the results of the current literature.
From 1979 until 2006, a total of 851 patients was treated at our institution by NSS. The mean tumor diameter was 3 cm (0.5-11 cm) for elective cases and 4.2 cm (1.2-11 cm) for imperative cases. The median follow-up for elective cases is 4.7 years (0.1-24.1 years) and imperative cases 8 years (0.1-25.8 years). Cancer-specific survival (CSS) and local recurrence-free survival (RFS) were estimated.
Estimated CSS at 5 and 10 years for elective indications were 98.5% and 96.7% and for imperative indications (solitary kidney) 89.6% and 76%. RFS after 5 and 10 years for elective indications were 98.3% and 95.7%; and for imperative indications (solitary kidney) 89.4% and 79.9%. Chronic renal failure requiring haemodialysis developed after NSS in a solitary kidney in nine patients (11.2%).
NSS can be performed with oncologically safe and good functional results in imperative indications. In elective indications the resectability of a tumour rather than size and location is the limiting factor.
对于双侧肾脏或单肾患有肾肿瘤的患者，为保留肾功能，保肾手术（NSS）是必要的（绝对适应证）。对于对侧肾脏正常的小型单侧肾肿瘤（<4 cm），NSS也已成为金标准（选择性适应证）。我们报告了我们自己系列的NSS肿瘤学长期随访情况，并讨论了当前文献的结果。
从1979年到2006年，我们机构共对851例患者进行了NSS治疗。选择性病例的平均肿瘤直径为3 cm（0.5 - 11 cm），绝对适应证病例为4.2 cm（1.2 - 11 cm）。选择性病例的中位随访时间为4.7年（0.1 - 24.1年），绝对适应证病例为8年（0.1 - 25.8年）。评估了癌症特异性生存率（CSS）和局部无复发生存率（RFS）。
选择性适应证5年和10年的估计CSS分别为98.5%和96.7%，绝对适应证（单肾）分别为89.6%和76%。选择性适应证5年和10年后的RFS分别为98.3%和95.7%；绝对适应证（单肾）分别为89.4%和79.9%。9例（11.2%）单肾患者在NSS后出现需要血液透析的慢性肾衰竭。
在绝对适应证中，NSS可在肿瘤学上安全进行并取得良好的功能结果。在选择性适应证中，肿瘤的可切除性而非大小和位置是限制因素。
