Division of Urology, Federal University of São Paulo, São Paulo, Brazil.
J Endourol. 2011 Mar;25(3):471-6. doi: 10.1089/end.2010.0254. Epub 2011 Mar 1.
Bosniak III and IV renal cysts have low mortality potential, and little is reported regarding the feasibility and safety of managing such tumors by laparoscopy and its comparison with open surgery. We report on the experience with 37 complex renal cysts managed in the era of laparoscopy.
A retrospective analysis of a prospective database from all patients with renal tumors who were operated on at our institution was evaluated after Institutional Review Board approval. The database comprises information for demographic, clinical, imaging, preoperative, intraoperative, histologic, and follow-up data. A comparison among all performed approaches was done for demographic, American Society of Anesthesiologists classification, operative time, estimated blood loss, ischemia time, hospital stay, oncologic and survival rate. The cysts removed by laparoscopic partial nephrectomy were compared with the solid tumors removed by the same approach at the same period.
The database included 407 patients with renal tumors who were operated on from 2000 to 2009 at our institution. In 36 patients of the total cohort, there were 37 complex renal cysts. No patients with preoperative Bosniak type I or II underwent surgery. Of the cysts, 60% were Bosniak IV, and 86% were confirmed as malignant; 40% were Bosniak III, and 44% were confirmed as malignant. Laparoscopic partial nephrectomy was performed in 67.5%. The tumor size and hospital stay were significantly different in the laparoscopic group. No cyst spillage occurred either by laparoscopy or by the open approach, and no tumor recurrence was found in a mean follow-up of 43.7 months with overall survival of 100%.
Laparoscopic surgery for complex cysts is safe, feasible, and effective. Nevertheless, regardless of surgical approach, patients with complex renal cysts have excellent overall survival with short-term follow-up.
Bosniak III 和 IV 级肾囊肿的死亡率较低，关于通过腹腔镜手术治疗此类肿瘤的可行性和安全性，以及与开放手术相比的情况，报道较少。我们报告了在腹腔镜时代对 37 例复杂肾囊肿进行管理的经验。
在机构审查委员会批准后，对所有在我们机构接受肾肿瘤手术的患者的前瞻性数据库进行了回顾性分析。该数据库包含人口统计学、临床、影像学、术前、术中、组织学和随访数据。对所有手术方法进行了比较，包括人口统计学、美国麻醉医师协会分类、手术时间、估计失血量、缺血时间、住院时间、肿瘤学和生存率。比较了腹腔镜部分肾切除术切除的囊肿与同期相同方法切除的实体肿瘤。
数据库包括 2000 年至 2009 年在我们机构接受手术的 407 例肾肿瘤患者。在总队列的 36 名患者中，有 37 例复杂肾囊肿。没有术前 Bosniak Ⅰ或Ⅱ型的患者接受了手术。这些囊肿中，60%为 Bosniak Ⅳ级，86%被证实为恶性；40%为 Bosniak Ⅲ级，44%被证实为恶性。腹腔镜部分肾切除术的比例为 67.5%。腹腔镜组的肿瘤大小和住院时间有显著差异。腹腔镜或开放手术均未发生囊肿溢出，在平均随访 43.7 个月后，总体生存率为 100%，未发现肿瘤复发。
腹腔镜手术治疗复杂囊肿是安全、可行和有效的。然而，无论手术方式如何，复杂肾囊肿患者的总体生存率均较高，短期随访结果良好。
