Kanno Toru, Kubota Masashi, Sakamoto Hiromasa, Nishiyama Ryuichi, Oida Tomoyuki, Okada Takashi, Akao Toshiya, Higashi Yoshihito, Kawamura Juichi, Yamada Hitoshi
The Department of Urology, Ijinkai Takeda General Hospital, Kyoto.
The Department of Urology, Graduate School of Medicine, Kyoto University.
Nihon Hinyokika Gakkai Zasshi. 2016;107(2):73-78. doi: 10.5980/jpnjurol.107.73.
(Objectives) Nephron sparing surgery (NSS) is strongly recommended for patients with T1a renal cell carcinoma (RCC) whenever surgically feasible. However, partial nephrectomy, particularly laparoscopic approach, remains underutilized in Japan compared to laparoscopic radical nephrectomy (LRN). In this study, we examined the safety and efficacy of laparoscopic partial nephrectomy (LPN) for T1a RCC compared to LRN. We also assessed the factors that affect the decision to perform LPN or LRN. (Patients and methods) From March 2001 to September 2014, 112 patients with T1a renal tumors received renal surgery at our institution. Of these, 100 patients (LPN: 36 patients, LRN: 64 patients) underwent laparoscopic surgery. Treatment outcomes including surgical and oncological outcomes among each approach were compared. In addition, multivariate analysis was performed to reveal the factors that affect the decision on surgical approach. (Results) The ratio of patients more than 75 years old and the RENAL nephrometry score were higher in LRN group than those in LPN group. Operating time was longer but renal function was well preserved in LPN group. Importantly, blood loss, intraoperative and postoperative complication rate, and oncological outcome (recurrence-free survival and overall survival) were similar in both groups. Multivariate analysis revealed that age (≥75 years old), high RENAL nephrometry score, operation period (before 2011), and the absence of Endoscopic Surgical Skill Qualification (ESSQ) in surgeon were independent predictive factors that select LRN. (Conclusions) Our data suggests that LPN for T1a renal tumor could be performed safely and the decision whether LPN or LRN were performed were associated with technical factors such as the presence of ESSQ or operation period, as well as patient's factor such as age and tumor factor such as tumor complexity.
（目的）只要手术可行，对于T1a期肾细胞癌（RCC）患者强烈推荐保留肾单位手术（NSS）。然而，与腹腔镜根治性肾切除术（LRN）相比，部分肾切除术，尤其是腹腔镜手术方式，在日本的应用仍然不足。在本研究中，我们比较了腹腔镜部分肾切除术（LPN）与LRN治疗T1a期RCC的安全性和有效性。我们还评估了影响选择LPN或LRN的因素。（患者和方法）2001年3月至2014年9月，112例患有T1a期肾肿瘤的患者在我院接受了肾脏手术。其中，100例患者（LPN组：36例患者，LRN组：64例患者）接受了腹腔镜手术。比较了每种手术方式的治疗结果，包括手术和肿瘤学结果。此外，进行多因素分析以揭示影响手术方式选择的因素。（结果）LRN组中75岁以上患者的比例和RENAL肾计量评分高于LPN组。LPN组手术时间较长，但肾功能得到了良好的保留。重要的是，两组的失血量、术中和术后并发症发生率以及肿瘤学结果（无复发生存率和总生存率）相似。多因素分析显示，年龄（≥75岁）、RENAL肾计量评分高、手术时间（2011年之前）以及外科医生缺乏内镜手术技能资格（ESSQ）是选择LRN的独立预测因素。（结论）我们的数据表明，T1a期肾肿瘤的LPN可以安全进行，选择LPN还是LRN与技术因素如ESSQ的存在或手术时间有关，也与患者因素如年龄和肿瘤因素如肿瘤复杂性有关。
