Alvim Ricardo G, Tin Amy L, Nogueira Lucas, Wong Nathan C, Fonseca Renato C, Sjoberg Daniel D, Hakimi A Ari, Touijer Karim A, Russo Paul, Coleman Jonathan A
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
Urology. 2021 Nov;157:174-180. doi: 10.1016/j.urology.2021.07.014. Epub 2021 Jul 29.
To describe the safety and efficacy of partial nephrectomy (PN) in comparison to radical nephrectomy (RN) for surgically managed renal hilar tumors.
We retrospectively reviewed institutional records of patients with a small (<5 cm) solitary renal (hilar or non-hilar) mass who underwent PN or RN between 2008 and 2018. Hilar tumors were defined as those at medial position, abutting the renal vessels. Recurrence-free, cancer-specific, and overall survival were estimated using the Kaplan-Meier method.
Of 1,951 eligible patients, 399 had hilar tumors (292 scheduled for PN, 107 RN) and 1,552 had non-hilar tumors (scheduled for PN). We found no significant differences in survival measures between hilar and non-hilar tumors in patients selected for PN. Patients scheduled for PN for hilar tumors had higher rates of ≥grade II postoperative surgical complications compared to patients scheduled to receive PN for non-hilar tumors (13% vs 8.6%; log-rank P = .018) and non-statistically significantly elevated rates of ≥grade II complications compared to patients scheduled for RN for hilar tumors (13% vs 6.5%; difference 6%, 95% CI 0.4%, 13%; log-rank P = .07).
PN for hilar and non-hilar renal masses (<5cm) experience comparable oncologic outcomes though increased risk of complications for hilar masses. PN for hilar tumors was associated with better renal function and overall survival with non-statistically elevated risk of grade II or higher complications than RN. A renal tumor located at the hilum should not be a contra-indication for performing PN.
描述与根治性肾切除术（RN）相比，保留肾单位手术（PN）治疗肾门部肿瘤的安全性和有效性。
我们回顾性分析了2008年至2018年间接受PN或RN治疗的孤立性肾肿块（<5 cm）患者（肾门部或非肾门部）的机构记录。肾门部肿瘤定义为位于内侧、毗邻肾血管的肿瘤。采用Kaplan-Meier法评估无复发生存率、癌症特异性生存率和总生存率。
在1951例符合条件的患者中，399例患有肾门部肿瘤（292例计划行PN，107例计划行RN），1552例患有非肾门部肿瘤（计划行PN）。我们发现，接受PN治疗的患者中，肾门部肿瘤和非肾门部肿瘤的生存指标无显著差异。与计划接受PN治疗的非肾门部肿瘤患者相比，计划接受PN治疗的肾门部肿瘤患者术后≥Ⅱ级手术并发症发生率更高（13%对8.6%；对数秩检验P = 0.018），与计划接受RN治疗的肾门部肿瘤患者相比，≥Ⅱ级并发症发生率虽无统计学意义但有所升高（13%对6.5%；差异6%，95%CI 0.4%，13%；对数秩检验P = 0.07）。
对于肾门部和非肾门部肾肿块（<5cm），PN的肿瘤学结局相当，尽管肾门部肿块并发症风险增加。肾门部肿瘤行PN与更好的肾功能和总生存率相关，与RN相比，Ⅱ级或更高并发症的风险虽无统计学意义但有所升高。位于肾门部的肾肿瘤不应成为行PN的禁忌证。
