Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA.
Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA.
Urol Int. 2022;106(4):419-425. doi: 10.1159/000516697. Epub 2021 Jun 28.
The aim of the study was to describe our experience in patients who underwent nephron-sparing surgery (NSS) with tumor thrombectomy.
Three consecutive patients who underwent NSS and tumor thrombectomy for localized single/multifocal renal cell carcinomas (RCCs) in conjunction with tumor thrombus between 2007 and 2011 were included. Open partial nephrectomy and thrombectomy was performed. Reconstruction included main renal vein, collecting system, and remaining parenchymal closure. One of the cases required additional artery repair and flushing with preservation solution.
Ischemic time was kept for 30-40 min. Mean estimated blood loss was 183.3 cc (range:100-300). One patient required the transfusion of 1 packed red blood cells unit. One of the patients developed a urinary fistula requiring double-J stenting. Hospital staying ranged between 5 and 8 days. None of the patients required renal replacement therapy either postoperatively or in the follow-up. Serum creatinine level at last follow-up (mean 83 months) ranged from 0.8 to 2.8 mg/dL.
Our experience supports the feasibility of imperative partial nephrectomy and tumor thrombectomy for cases of RCC with renal vein involvement by tumor thrombus. In experienced hands, this approach may offer the patient a low morbidity postoperative course and long-term freedom from disease while maintaining the renal function, thus avoiding the need of renal replacement therapy.
本研究旨在描述我们在接受肾部分切除术（NSS）联合肿瘤栓子切除术的患者中的经验。
纳入 2007 年至 2011 年间连续 3 例接受 NSS 和肿瘤栓子切除术治疗局限性单发/多发肾细胞癌（RCC）合并肿瘤栓子的患者。采用开放部分肾切除术和栓子切除术。重建包括主肾静脉、收集系统和剩余实质的闭合。其中 1 例需要额外的动脉修复和用保存液冲洗。
缺血时间保持在 30-40 分钟。平均估计失血量为 183.3cc（范围：100-300）。1 例患者需要输注 1 个单位的浓缩红细胞。1 例患者发生尿瘘，需要双 J 支架置入。住院时间为 5-8 天。术后或随访期间均无需行肾脏替代治疗。末次随访时（平均 83 个月）血清肌酐水平为 0.8-2.8mg/dL。
我们的经验支持在经验丰富的医生手中，对合并肾静脉受累肿瘤栓子的 RCC 患者进行强制性部分肾切除术和肿瘤栓子切除术的可行性。这种方法可能为患者提供低术后发病率和长期无病生存率，同时保持肾功能，从而避免需要肾脏替代治疗。
