Zagreb University Hospital Center, Department of Urology, Zagreb, Croatia.
University of Zagreb, School of Medicine, Zagreb, Croatia.
Acta Clin Croat. 2023 Jul;62(Suppl2):53-59. doi: 10.20471/acc.2023.62.s2.8.
The majority of renal neoplasms can be treated surgically using open or minimally-invasive approach. Nephron-sparing surgery should be used when possible, regardless to the operative approach. In this retrospective study, we analyzed surgical trends of operative treatment of renal neoplasms in the period from February 2011 until December 2020. There were a total of 1031 procedures, 703 (68.2%) radical nephrectomies (RN) and 328 (31.8%) partial nephrectomies (PN). Laparoscopic approach was used in 211 (20.5%) (111 PN and 100 RN), while open approach was used in 820 (79.5%) (328 PN and 703 RN) cases. There were 12 procedures performed with the use of cardiopulmonary bypass and hypothermic arrest. The median operative time was 161 minutes for open RN and 158 for open PN, 160 for laparoscopic RN, and 162 for laparoscopic PN. The most common pathology was clear cell carcinoma in 693 (67.3%), papillary carcinoma in 115 (11.2%), chromophobe carcinoma in 67 (6.5%), oncocytoma in 46 (4.5%), and angiomyolipoma in 33 (3.2%) patients. Pathologically, pT1 stage was diagnosed in 56.9%, pT2 in 5.8%, pT3 in 22.4% and pT4 in 1.2% of patients. Regional lymphadenectomy was performed in 354 (34.3%) patients, among which lymph nodes were positive in 40 (11.3%) cases. Surgical margins were positive in 27 cases when PN was performed (8.2%). In conclusion, there was an ongoing raising trend in the number of procedures in general, and also in minimally invasive and nephron-sparing surgery in our study.
大多数肾肿瘤可以通过开放或微创方法进行手术治疗。无论手术方式如何，都应尽可能采用保肾手术。在这项回顾性研究中，我们分析了 2011 年 2 月至 2020 年 12 月期间肾肿瘤手术治疗的手术趋势。共有 1031 例手术，703 例（68.2%）根治性肾切除术（RN）和 328 例（31.8%）部分肾切除术（PN）。腹腔镜方法用于 211 例（20.5%）（111 例 PN 和 100 例 RN），而开放方法用于 820 例（79.5%）（328 例 PN 和 703 例 RN）。有 12 例手术采用心肺旁路和低温停搏。开放 RN 的中位手术时间为 161 分钟，开放 PN 为 158 分钟，腹腔镜 RN 为 160 分钟，腹腔镜 PN 为 162 分钟。最常见的病理类型是透明细胞癌 693 例（67.3%），乳头状癌 115 例（11.2%），嫌色细胞癌 67 例（6.5%），嗜酸细胞瘤 46 例（4.5%）和血管平滑肌脂肪瘤 33 例（3.2%）。病理上，pT1 期诊断为 56.9%，pT2 期为 5.8%，pT3 期为 22.4%，pT4 期为 1.2%。354 例（34.3%）患者行区域淋巴结清扫术，其中 40 例（11.3%）淋巴结阳性。PN 时手术切缘阳性 27 例（8.2%）。总之，本研究中，手术数量总体呈上升趋势，微创和保肾手术也呈上升趋势。
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