Morgan W R, Zincke H
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905.
J Urol. 1990 Oct;144(4):852-7; discussion 857-8. doi: 10.1016/s0022-5347(17)39608-8.
Of 104 patients who underwent a conservative operation for renal cell carcinoma 42 underwent partial nephrectomy, 60 underwent enucleation and 2 underwent a combination of these procedures. A total of 14 patients required an extracorporeal operation with autotransplantation. Forty patients had bilateral renal cell carcinoma (20 were synchronous and 20 were asynchronous) and 39 had either a solitary kidney or a poorly functioning contralateral renal unit. An operation was performed in the presence of a normal contralateral unit in 20 patients. The maximal duration of followup was 20 years (mean 4.9 years): 43, 17 and 7 patients were followed for 5 or more, 10 or more and 15 or more years, respectively. The 5-year cause-specific survival rates were 88.6 +/- 5.6, 91.6 +/- 4.7 and 88.9 +/- 3.8%, respectively, for the enucleation group, partial nephrectomy group and all patients combined. The percentages of patients free of local recurrence at 5 years for the enucleation and partial nephrectomy groups were 94.6 +/- 3.9 and 93.3 +/- 4.7%, respectively. The 14 patients who required an ex vivo approach had larger, higher stage and higher grade tumors, and a poorer outcome (5-year cause-specific survival rate and local rate free of recurrence were 54.9 +/- 17.2 and 85.7 +/- 13.2%, respectively). None of the 20 patients with a normal contralateral unit had progression. The local survival rate free of disease and cause-specific survival rate were not significantly different for the simple enucleation and partial nephrectomy groups. Even longer followup is needed to assess more clearly the definitive role of simple enucleation in the treatment of renal cell carcinoma and the clinical relevance of possible positive margins in a patient population that usually is older.
在104例行肾细胞癌保守手术的患者中，42例行部分肾切除术，60例行肿瘤剜除术，2例行这两种手术的联合操作。共有14例患者需要进行体外手术及自体肾移植。40例患者患有双侧肾细胞癌（20例为同时性，20例为异时性），39例患者有孤立肾或对侧肾功能不良。20例患者在对侧肾单位正常的情况下接受了手术。随访的最长时间为20年（平均4.9年）：分别有43例、17例和7例患者随访了5年或更长时间、10年或更长时间以及15年或更长时间。肿瘤剜除术组、部分肾切除术组及所有患者合并后的5年病因特异性生存率分别为88.6±5.6%、91.6±4.7%和88.9±3.8%。肿瘤剜除术组和部分肾切除术组5年无局部复发患者的百分比分别为94.6±3.9%和93.3±4.7%。14例需要体外手术的患者肿瘤更大、分期更高、分级更高，预后较差（5年病因特异性生存率和无复发局部率分别为54.9±17.2%和85.7±13.2%）。20例对侧肾单位正常的患者均无病情进展。单纯肿瘤剜除术组和部分肾切除术组的无病局部生存率和病因特异性生存率无显著差异。需要更长时间的随访，以更清楚地评估单纯肿瘤剜除术在肾细胞癌治疗中的最终作用以及在通常年龄较大的患者群体中可能的切缘阳性的临床相关性。
