Kanno Toru, Kubota Masashi, Sakamoto Hiromasa, Nishiyama Ryuichi, Oida Tomoyuki, Okada Takashi, Akao Toshiya, Yamada Hitoshi
The Department of Urology, Ijinkai Takeda General Hospital.
Nihon Hinyokika Gakkai Zasshi. 2016;107(1):1-6. doi: 10.5980/jpnjurol.107.1.
(Objectives) Laparoscopic radical nephrectomy (LRN) is now a standard care for the treatment of renal tumors, but the limitation of LRN for large tumors remains to be elucidated. In this study, we examined the safety and efficacy of LRN for >7 cm renal tumors including tumors >10 cm. (Patients and methods) From March 2001 to September 2014, 167 patients received laparoscopic surgery for renal tumors at our institution. Of these, 126 patients (≤4.0 cm: 64 cases, 4.1-7.0 cm: 40 cases, 7.1-10.0 cm: 12 cases, >10.0 cm: 10 cases) underwent LRN. Treatment outcomes including surgical and oncological outcomes among each stage were compared. (Results) Operating time for 7.1-10.0 cm tumors were similar to that <7 cm tumors but that for >10 cm tumors was significantly longer than that <10 cm tumors. There was no significant difference among each stage in terms of complication rate. As expected, recurrence-free survival rate for >10 cm tumors were worse than <10 cm tumors. (Conclusions) Our data suggests that LRN for large tumors >7 cm can be performed safely, but LRN for >10 cm tumors are technically demanding and require longer operation time.
（目的）腹腔镜根治性肾切除术（LRN）目前是治疗肾肿瘤的标准治疗方法，但LRN对大肿瘤的局限性仍有待阐明。在本研究中，我们研究了LRN治疗直径>7 cm肾肿瘤（包括直径>10 cm的肿瘤）的安全性和有效性。（患者与方法）2001年3月至2014年9月，167例患者在我院接受了肾肿瘤的腹腔镜手术。其中，126例患者（≤4.0 cm：64例，4.1 - 7.0 cm：40例，7.1 - 10.0 cm：12例，>10.0 cm：10例）接受了LRN。比较了各阶段的治疗结果，包括手术和肿瘤学结果。（结果）直径7.1 - 10.0 cm肿瘤的手术时间与直径<7 cm肿瘤相似，但直径>10 cm肿瘤的手术时间明显长于直径<10 cm肿瘤。各阶段的并发症发生率无显著差异。正如预期的那样，直径>10 cm肿瘤的无复发生存率比直径<10 cm肿瘤差。（结论）我们的数据表明，LRN可以安全地用于治疗直径>7 cm的大肿瘤，但LRN治疗直径>10 cm的肿瘤技术要求高，且需要更长的手术时间。
