Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Curr Opin Urol. 2012 Sep;22(5):365-71. doi: 10.1097/MOU.0b013e3283551f84.
The incidence of renal cell carcinoma and the detection of incidental small renal masses are rising. Urologists are faced with difficult management decisions on how to treat patients with small renal masses. Traditionally, the treatment of suspicious renal masses was radical nephrectomy. However, nephron-sparing surgery is the standard of care, when possible, because of the risk of renal insufficiency associated with radical nephrectomy.
A large breadth of data have shown that partial nephrectomy has equivalent oncologic outcomes compared to radical nephrectomy. Recently, attempts to further spare renal parenchyma and perform nephron-sparing surgery in anatomically difficult scenarios have led to the development of the enucleation technique. Enucleation is performed by following the natural plane between the peritumor pseudocapsule and the renal parenchyma. This emerging technique was met with skepticism and concern for incomplete tumor removal. However, studies comparing enucleation and partial nephrectomy to date have revealed equivalent oncologic outcomes.
There has been a greater acceptance of tumor enucleation as a safe alternative for renal masses which are locally confined on preoperative imaging, easily delineated intraoperatively, and do not appear to grossly invade beyond the pseudocapsule.
肾细胞癌的发病率和偶然发现的小肾肿瘤的检出率都在上升。泌尿科医生在如何治疗小肾肿瘤患者方面面临着困难的治疗决策。传统上，对可疑肾肿瘤的治疗是根治性肾切除术。然而，当有可能时，保肾手术是标准的治疗方法，因为根治性肾切除术与肾功能不全的风险相关。
大量数据表明，部分肾切除术与根治性肾切除术的肿瘤学结果相当。最近，为了进一步保留肾实质并在解剖上困难的情况下进行保肾手术，人们开发了剜除技术。剜除术是通过遵循肿瘤假包膜和肾实质之间的自然平面进行的。这项新兴技术引起了怀疑和对肿瘤切除不完整的担忧。然而，目前比较剜除术和部分肾切除术的研究显示，肿瘤学结果相当。
对于术前影像学检查局限于局部、术中易于界定且似乎没有明显侵犯假包膜的肾肿瘤，肿瘤剜除术已被更广泛地接受为一种安全的替代方法。
