Division of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
Curr Opin Urol. 2013 Sep;23(5):403-10. doi: 10.1097/MOU.0b013e328363a5c0.
Nephron-sparing surgery is the standard of care for the treatment of localized renal tumours and is increasingly performed for larger and more challenging lesions. Aim of this review is to analyse the outcomes of partial nephrectomy for the treatment of T1b renal tumours greater than 4 cm in size.
No randomized trial has compared the outcomes of partial nephrectomy compared to radical nephrectomy for T1b renal tumours. However, several single, multi-institutional and population-based studies consistently showed similar cancer-specific survival rates for open partial nephrectomy (OPN) and radical nephrectomy for tumours greater than 4 cm in size. A decreased loss in renal function was observed with partial nephrectomy compared to radical nephrectomy for T1b tumours. Laparoscopic partial nephrectomy (LPN) for tumours greater than 4 cm in size was shown to obtain similar short-to-intermediate-term oncological outcomes of laparoscopic radical nephrectomy and OPN in experienced centres, but is associated with longer warm ischaemia time and higher complication rates. The initial series of robot-assisted partial nephrectomy show similar perioperative results and decreased warm ischaemia time compared to LPN, whereas the oncological outcomes are still immature.
Partial nephrectomy for T1b renal tumours achieves comparable oncological outcomes and better preservation of renal function compared to radical nephrectomy and should be performed whenever technically possible. OPN remains at present the gold standard technique. LPN represents an alternative to OPN in centres with advanced laparoscopic expertise. Robot-assisted partial nephrectomy has the potential to overcome the drawbacks of pure laparoscopic surgery, but larger series and longer follow-up are needed to further define its role in the management of T1b tumours.
保肾手术是治疗局限性肾肿瘤的标准治疗方法，并且越来越多地用于更大和更具挑战性的病变。本综述的目的是分析治疗大于 4cm 的 T1b 肾肿瘤的部分肾切除术的结果。
没有随机试验比较了部分肾切除术与根治性肾切除术治疗 T1b 肾肿瘤的结果。然而，几项单中心、多机构和基于人群的研究一致表明，对于大于 4cm 的肿瘤，开放性部分肾切除术（OPN）和根治性肾切除术的癌症特异性生存率相似。与根治性肾切除术相比，部分肾切除术观察到 T1b 肿瘤的肾功能丧失减少。在有经验的中心，对于大于 4cm 的肿瘤，腹腔镜部分肾切除术（LPN）与腹腔镜根治性肾切除术和 OPN 获得类似的短期至中期肿瘤学结果，但与更长的热缺血时间和更高的并发症发生率相关。机器人辅助部分肾切除术的初始系列显示，与 LPN 相比，具有相似的围手术期结果和减少的热缺血时间，而肿瘤学结果仍不成熟。
与根治性肾切除术相比，部分肾切除术治疗 T1b 肾肿瘤可获得相似的肿瘤学结果，并更好地保留肾功能，只要在技术上可行，就应进行部分肾切除术。目前，OPN 仍然是金标准技术。在具有先进腹腔镜专业知识的中心，LPN 是 OPN 的替代方法。机器人辅助部分肾切除术有可能克服纯腹腔镜手术的缺点，但需要更大的系列和更长的随访时间来进一步确定其在 T1b 肿瘤治疗中的作用。
