Wishnow K I, Lorigan J, Charnsangavej C J
Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston.
Urology. 1989 Oct;34(4):171-4. doi: 10.1016/0090-4295(89)90366-x.
Recently, several authorities have argued that, whenever surgically feasible, parenchyma-conserving surgery rather than radical nephrectomy should be the preferred treatment for renal cell carcinoma. They affirm that the results reported following partial nephrectomy are as good as those reported following radical nephrectomy for renal cell carcinoma. However, parenchyma-conserving surgery is usually performed only for relatively small, well-circumscribed tumors that do not involve the collecting system extensively or the renal hilum. To determine the results when radical nephrectomy is used to manage similar tumors, we reviewed the clinical records and arteriograms of 111 patients with renal cell carcinoma. Review of the arteriograms showed that parenchyma-conserving surgery could have been performed in 10 cases (9%). The disease-free survival rate for these 10 patients after radical nephrectomy was 100 percent, and they had no local recurrences. On the basis of these data, we believe that radical nephrectomy remains the best treatment for all patients who have renal cell carcinoma and a normal contralateral kidney.
最近，一些权威人士认为，只要手术可行，对于肾细胞癌，保留实质的手术而非根治性肾切除术应作为首选治疗方法。他们断言，肾部分切除术后报告的结果与肾细胞癌根治性肾切除术后报告的结果一样好。然而，保留实质的手术通常仅用于相对较小、边界清楚、未广泛累及集合系统或肾门的肿瘤。为了确定使用根治性肾切除术治疗类似肿瘤的结果，我们回顾了111例肾细胞癌患者的临床记录和动脉造影。对动脉造影的回顾显示，10例（9%）患者本可以进行保留实质的手术。这10例患者根治性肾切除术后的无病生存率为100%，且无局部复发。基于这些数据，我们认为根治性肾切除术仍然是所有患有肾细胞癌且对侧肾正常的患者的最佳治疗方法。
