Department of Urology, Mayo Clinic, Rochester, MN, USA.
Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA.
BJU Int. 2018 Aug;122(2):243-248. doi: 10.1111/bju.14221. Epub 2018 Apr 29.
To evaluate the peri-operative and renal functional outcomes of patients undergoing synchronous bilateral partial nephrectomy (PN) or percutaneous cryoablation (PCA).
We retrospectively reviewed our institutional nephrectomy and renal mass ablation registries to identify all patients with synchronous bilateral renal masses who underwent simultaneous bilateral PN (n = 76) or PCA (n = 13) between 1974 and 2013. Changes in estimated glomerular filtration rate (eGFR) as well as peri-operative complications are descriptively reported for each procedure.
The number of treated renal masses in the 76 patients in the PN group and the 13 patients in the PCA group was 249 and 28, respectively. The median (interquartile range [IQR]) age at treatment was 62 (50, 71) years for the PN group and 67 (56, 72) for the PCA group. The median (IQR) maximum tumour sizes were 4.6 (3.4, 6.5) cm and 2.6 (2.4, 3.2) cm for the PN and PCA groups, respectively. The median (IQR) length of hospital stay was 7 (5, 8) days for the PN group and 1 (1, 10) days for the PCA group. The median (IQR) change in eGFR from baseline to discharge was -32 (-46, -15)% for the PN group and -17% (-33, -3) for the PCA group. By 3 months, median (IQR) renal function improved, with changes of -9 (-19, 0)% and -8 (-11, 15)%, respectively, compared with baseline. No patient in either group required renal replacement therapy in the peri-operative period. Early postoperative complications (within 30 days) occurred in 16 patients (21.6%) in the PN and four patients in the PCA group. In particular, angioembolization for bleeding was required in the postoperative period in two patients (2.7%) in the PN and one patient in the PCA group.
Our experience suggests that synchronous bilateral PN or PCA are feasible treatment options for select patients presenting with bilateral renal masses. In select cases, both approaches appear to have reasonable rates of peri-operative complications and effects on renal function.
评估同期行双侧部分肾切除术（PN）或经皮冷冻消融术（PCA）的患者围手术期和肾功能结果。
我们回顾性分析了机构肾切除术和肾肿瘤消融登记处，以确定 1974 年至 2013 年间同期行双侧 PN（n=76）或 PCA（n=13）的双侧肾脏肿瘤同期患者。分别描述每种手术的肾小球滤过率（eGFR）变化和围手术期并发症。
PN 组 76 例患者和 PCA 组 13 例患者的治疗肾肿瘤数量分别为 249 个和 28 个。PN 组的中位（四分位距 [IQR]）年龄为 62（50，71）岁，PCA 组为 67（56，72）岁。最大肿瘤大小的中位数（IQR）分别为 4.6（3.4，6.5）cm 和 2.6（2.4，3.2）cm，分别为 PN 和 PCA 组。PN 组的中位（IQR）住院时间为 7（5，8）天，PCA 组为 1（1，10）天。PN 组的 eGFR 从基线到出院的中位数（IQR）变化为-32（-46，-15）%，PCA 组为-17（-33，-3）%。在 3 个月时，与基线相比，中位数（IQR）肾功能分别改善-9（-19，0）%和-8（-11，15）%。两组患者均无围手术期需要肾脏替代治疗。PN 组 16 例（21.6%）和 PCA 组 4 例患者术后 30 天内出现早期术后并发症。特别是，PN 组中有 2 例（2.7%）和 PCA 组中有 1 例患者需要在术后进行血管栓塞治疗出血。
我们的经验表明，同期双侧 PN 或 PCA 是治疗双侧肾脏肿瘤患者的可行选择。在选择病例中，两种方法似乎都有合理的围手术期并发症发生率和对肾功能的影响。
