Academic Department of Urology, La Pitié-Salpétrière Hospital, GHU EST, Assistance-Publique Hôpitaux de Paris, Hopital Pitié, Paris, France.
Ann Surg Oncol. 2011 Apr;18(4):1151-7. doi: 10.1245/s10434-010-1457-6. Epub 2010 Dec 7.
To determine the effect of nephron-sparing surgery (NSS) on cancer control in renal cell carcinomas (RCC) and to compare the outcomes of patients who had elective versus imperative indications for surgery.
We performed a retrospective review of the data for patients treated with open NSS between 1980 and 2005 for sporadic RCCs. The following data were analyzed: age, intraoperative parameters, tumor size, Fuhrman grade, tumor, node, metastasis system disease stage, pathological data, and outcome.
A total of 155 patients with a median age of 60 years were included. The mean preoperative and postoperative creatinine levels were 1.1 ± 0.3 mg/dl (range 0.6-2.6 mg/dl) and 1.2 ± 0.4 mg/dl (range 0.5-3.4 mg/dl), respectively. The mean tumor size was 3.8 ± 2 cm (range 1-10 cm). Margin status was positive in 15 cases (9.70%), and multifocal RCCs were observed in 36 patients (23.2%). Overall, NSS indications were elective in 96 cases (61.9%) and imperative in 59 cases (38.1%). Univariate analysis found that elective cases were associated with better perioperative outcomes (P = 0.01). In univariate analysis, tumor, node, metastasis system disease stage, multifocality, and indication were associated with recurrence (P < 0.05). In the multivariate analysis, only multifocality status and imperatives indications were significant (P < 0.05). The mean follow-up was 118.2 ± 151 months. The 5- and 10-year tumor-free survival rates were 81.8% and 78.7% in elective and imperatives cases, respectively.
Oncologic control seems to be better for cases of elective open NSS. Thus, NSS should be advocated as soon as it is technically possible, regardless of the size of the tumor.
确定保肾手术（NSS）对肾细胞癌（RCC）肿瘤控制的影响，并比较有选择性手术和紧急手术指征的患者的治疗结果。
我们对 1980 年至 2005 年间接受开放性 NSS 治疗的散发性 RCC 患者的数据进行了回顾性分析。分析的内容包括：年龄、术中参数、肿瘤大小、Fuhrman 分级、肿瘤、淋巴结、转移系统疾病分期、病理数据和治疗结果。
共纳入 155 例中位年龄为 60 岁的患者。术前和术后血肌酐水平的平均值分别为 1.1±0.3mg/dl（范围 0.6-2.6mg/dl）和 1.2±0.4mg/dl（范围 0.5-3.4mg/dl）。肿瘤的平均大小为 3.8±2cm（范围 1-10cm）。15 例（9.70%）切缘阳性，36 例（23.2%）为多灶性 RCC。总体而言，96 例（61.9%）为选择性手术，59 例（38.1%）为紧急手术。单因素分析发现，选择性手术的围手术期结果更好（P=0.01）。单因素分析显示，肿瘤、淋巴结、转移系统疾病分期、多灶性和手术指征与肿瘤复发有关（P<0.05）。多因素分析显示，只有多灶性状态和紧急手术指征具有显著意义（P<0.05）。平均随访时间为 118.2±151 个月。选择性和紧急性手术的 5 年和 10 年肿瘤无复发生存率分别为 81.8%和 78.7%。
对于选择性开放 NSS，肿瘤控制似乎更好。因此，只要技术上可行，无论肿瘤大小如何，都应提倡进行 NSS。
