Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland 21287, USA.
Urology. 2012 Mar;79(3):570-5. doi: 10.1016/j.urology.2011.10.065.
To analyze the perioperative and oncologic outcomes of >7 cm renal tumors treated with laparoscopic radical nephrectomy (LRN) at a high-volume academic center. The indications for LRN have expanded to include larger (>7 cm) lesions.
The Institutional Minimally Invasive Urologic Surgery Database (1994 to the present) was reviewed for patients undergoing LRN for >7-cm masses (American Joint Committee on Cancer clinical Stage T2N0M0).
Of 200 patients, 138 (69.0%) had tumors >7.0-10 cm and 62 (31.0%) had tumors >10 cm. The patients with tumors >10 cm presented more often with symptoms, most often hematuria, and more often had high-grade tumors (68% vs 44%, P = .005). Also, a greater proportion were papillary renal cell carcinoma (23% vs 14%, P = .09) and were more often upstaged (21% vs 9%, P = .02). Of the 200 tumors, 74 (37%) were upstaged, 58 (29%) with perinephric extension and 26 (13%) with renal vein invasion. Larger tumors had greater blood loss on average (406 vs 288 mL, respectively, P = .1) and were converted to open surgery more often (13.8% vs 2.1%, P = .001). A total of 47 patients (22.3%) experienced a postoperative complication. The 5-year recurrence-free survival and cancer-specific survival rate was 62.4% and 92.9%, respectively. The significant predictors of recurrence-free survival in the multivariate model were clear cell histologic type, high Fuhrman grade, renal vein invasion, and perinephric extension. Of note, pT2b was not a predictor of recurrence.
LRN can have favorable perioperative and oncologic outcomes for large (>7 cm) renal masses, with an open conversion rate and complication rate of 5% and 20%, respectively. Clear cell histologic features, high-grade tumors, renal vein invasion, and perinephric extension, but not tumor size, were poor prognostic indicators in this cohort.
分析在高容量学术中心接受腹腔镜根治性肾切除术（LRN）治疗的>7cm 肾肿瘤的围手术期和肿瘤学结果。LRN 的适应证已扩大到包括更大（>7cm）的病变。
回顾分析 1994 年至目前机构微创泌尿外科数据库中接受 LRN 治疗>7cm 肿块（美国癌症联合委员会临床分期 T2N0M0）的患者。
200 例患者中，138 例（69.0%）肿瘤>7.0-10cm，62 例（31.0%）肿瘤>10cm。肿瘤>10cm 的患者更常出现症状，最常见的是血尿，且更常出现高级别肿瘤（68%比 44%，P=0.005）。此外，乳头状肾细胞癌的比例更高（23%比 14%，P=0.09），且更常分期较高（21%比 9%，P=0.02）。200 个肿瘤中，74 个（37%）分期升高，58 个（29%）有肾周延伸，26 个（13%）有肾静脉侵犯。较大的肿瘤平均出血量更大（分别为 406 毫升和 288 毫升，P=0.1），更常转为开放性手术（13.8%比 2.1%，P=0.001）。共有 47 例（22.3%）发生术后并发症。5 年无复发生存率和癌症特异性生存率分别为 62.4%和 92.9%。多变量模型中无复发生存的显著预测因素为透明细胞组织学类型、高 Fuhrman 分级、肾静脉侵犯和肾周延伸。值得注意的是，pT2b 不是复发的预测因素。
LRN 治疗>7cm 肾肿瘤的围手术期和肿瘤学结果良好，开放转化率和并发症发生率分别为 5%和 20%。在该队列中，透明细胞组织学特征、高级别肿瘤、肾静脉侵犯和肾周延伸，但不是肿瘤大小，是预后不良的指标。
