Washington University School of Medicine, Department of Surgery, Division of Urologic Surgery, St Louis, MO 63110, USA.
BJU Int. 2012 May;109(9):1345-8. doi: 10.1111/j.1464-410X.2011.10477.x. Epub 2011 Aug 24.
Study Type--Therapy (case series). Level of Evidence 4. What's known on the subject? And what does the study add? Although nephron-sparing surgery (NSS) has became accepted therapy for T1 tumours, radical nephrectony is considered the best therapy for T3a tumours involving the renal vein. NSS can be considered in T3a or greater tumours if imperative indications exist, such as bilateral disease or solitary kidney. However, there is little published data on the characteristics of these patients, the impact of surgery on their renal function, and long-term oncologic outcomes. This study profiles single-institution experience with nephron-sparing surgery for known T3a tumours involving the renal vein, including patient characteristics, tumour characteristics, preoperative and follow-up imaging, preoperative and follow-up estimated glomerular filtration rate, length of temporary postoperative haemodialysis, and oncologic outcome. Additionally, we compare this to other published data on nephron-sparing surgery for similar tumors.
• To present two patients with T3a tumours involving the renal vein who underwent nephron-sparing surgery (NSS) for imperative reasons.
• Retrospective chart review of patients who underwent NSS for renal cell carcinoma (RCC) with known renal vein tumour thrombus (RVTT). • Both patients underwent open partial nephrectomy and renal vein thrombectomy of a solitary kidney. • Primary outcomes of the study include radiographic evidence of recurrence, haemodialysis requirement and estimated glomerular filtration rate (eGFR) before and after surgery.
• Patient 1 is 24 months from NSS and has no evidence of recurrence based on CT scan. His final pathology revealed a 9-cm, T3a, clear cell, Fuhrman grade II carcinoma. He spent 42 days on haemodialysis and is now off all dialysis. His preoperative and most recent eGFR are 48 and 23 mL/min/1.73 m(2) based on the Modification of Diet in Renal Disease (MDRD) equation and 69.4 and 29.8 mL/min by the Cockcroft-Gault equation. • Patient 2 is 9 months from NSS and has no evidence of recurrence based on CT scan. Her final pathology revealed a 6-cm, T3a, clear cell, Fuhrman grade II-III carcinoma. She spent 30 days on haemodialysis and is now off all dialysis. Her preoperative and most recent eGFR are 58 and 30 mL/min/1.73 m(2) based on the MDRD equation and 62.2 and 32.8 mL/min by the Cockcroft-Gault equation.
• Based on our review, preservation of renal function and favourable oncological outcome can be accomplished with NSS in patients with known stage T3a RCC with RVTT and should be considered in carefully selected patients.
介绍两名因紧急原因接受保肾手术（NSS）治疗肾静脉受累 T3a 肿瘤的患者。
回顾性分析接受 NSS 治疗已知肾静脉肿瘤血栓（RVTT）的肾细胞癌（RCC）患者的病历。两名患者均接受开放部分肾切除术和孤立肾静脉血栓切除术。研究的主要结局包括影像学复发证据、手术前后血液透析需求和估算肾小球滤过率（eGFR）。
患者 1 接受 NSS 后 24 个月，根据 CT 扫描未见复发迹象。他的最终病理显示为 9cm、T3a、透明细胞、Fuhrman 分级 II 级癌。他接受了 42 天的血液透析，现已停止透析。根据 MDRD 方程，他的术前和最近的 eGFR 分别为 48 和 23mL/min/1.73m²，根据 Cockcroft-Gault 方程分别为 69.4 和 29.8mL/min。患者 2 接受 NSS 后 9 个月，根据 CT 扫描未见复发迹象。她的最终病理显示为 6cm、T3a、透明细胞、Fuhrman 分级 II-III 级癌。她接受了 30 天的血液透析，现已停止透析。根据 MDRD 方程，她的术前和最近的 eGFR 分别为 58 和 30mL/min/1.73m²，根据 Cockcroft-Gault 方程分别为 62.2 和 32.8mL/min。
根据我们的回顾，在仔细选择的患者中，保肾手术（NSS）可保留肾功能并获得良好的肿瘤学结果，可用于治疗已知 T3a 期伴 RVTT 的 RCC 患者。
