[T期肾肿瘤保留肾单位手术的最佳手术切缘]

[The Optimal Surgical Margins of Nephron-sparing Surgery for Stage T Renal Tumors].

作者信息

Zhao Guo-Bin, Wang Yu, Tang Yu-Hong, Li Jian-Long, Feng Chao, Li Xiang-Dong

机构信息

Department of Urology, the First Affiliated Hospital of Hebei North University, Zhangjiakou 075000.

College of Laboratory Medicine, Hebei North University, Zhangjiakou 075000, China.

出版信息

Sichuan Da Xue Xue Bao Yi Xue Ban. 2020 Jul;51(4):552-555. doi: 10.12182/20200760504.

DOI:10.12182/20200760504

PMID:32691566

Abstract

OBJECTIVE

To analyze the pathological characteristics and explore the optimal surgical margins (SM) of nephron-sparing surgery (NSS) for stage T renal carcinoma (4-7 cm) on preoperative imaging.

METHODS

The clinical and pathological data of 245 cases of stage T kidney cancer from September 2013 to December 2017 were collected and reviewed retrospectively. The radical nephrectomy (RN) was performed on 174 cases and other 71 cases accepted NSS. There were 158 males and 87 females, with a mean age of 59.6 years and mean tumor size of 5.3 cm.

RESULTS

Through postoperative pathological examination, 209 (85.3%) cases were confirmed renal clear cell carcinoma and 219 (89.4%) cases were surrounded with visible peritumoralpseudocapsule (PC). 26 (10.6%) cases of cancerous cells invaded beyond peritumoral PC and into renal parenchyma. The infiltrative depth into renal parenchyma beyond PC was all limited in 3 mm and the cases of ≤1, 1-2 and 2-3 mm were 7 (26.9%), 16 (61.5%) and 3 (11.5%), respectively. Multifocal tumors were discovered in 24 (9.8%) cases. The average resection margin for partial nephrectomy was 5 mm (3-7 mm).

CONCLUSION

For stage T renal tumors, NSS is acceptable and a 3 mm of surgical margin is safe and suitable to avoid positive SM.

摘要

目的

分析术前影像学检查显示的T期（4 - 7 cm）肾癌保留肾单位手术（NSS）的病理特征，探讨最佳手术切缘（SM）。

方法

回顾性收集并分析2013年9月至2017年12月期间245例T期肾癌患者的临床及病理资料。其中174例行根治性肾切除术（RN），71例行NSS。患者中男性158例，女性87例，平均年龄59.6岁，平均肿瘤大小5.3 cm。

结果

术后病理检查显示，209例（85.3%）为肾透明细胞癌，219例（89.4%）有可见的肿瘤周围假包膜（PC）。26例（10.6%）癌细胞侵犯超出肿瘤周围PC并进入肾实质。超出PC进入肾实质的浸润深度均局限于3 mm以内，浸润深度≤1 mm、1 - 2 mm和2 - 3 mm的病例分别为7例（26.9%）、16例（61.5%）和3例（11.5%）。24例（9.8%）发现多灶性肿瘤。部分肾切除术的平均切缘为5 mm（3 - 7 mm）。