Lerner S E, Tsai H, Flanigan R C, Trump D L, Fleischmann J
Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Urology. 1995 Apr;45(4):574-7. doi: 10.1016/S0090-4295(99)80045-4.
The performance of nephron-sparing surgery in patients with a normally functioning contralateral kidney is controversial. To explore the risk factors that may contribute to the success or failure of nephron-sparing surgery, we examined the radiology and pathology reports of 278 patients who underwent radical nephrectomy for the treatment of clinically localized renal cell carcinoma.
We collated patient data from the records of 278 patients with Stage III renal cell carcinoma entered into the Eastern Cooperative Oncology Group protocol EST 2886 and compared preoperative clinical staging with postoperative pathologic results. Patients were considered potential candidates for nephron-sparing surgery if their preoperative radiographic studies indicated that the carcinoma was a single polar lesion 5 cm or less in diameter.
Of 278 radical nephrectomy specimens, 36 had primary lesions 5 cm or less in diameter. Preoperative radiographic studies showed 14 of 36 would not have been considered eligible for nephron-sparing surgery. Of the remaining 22 potential candidates, pathologic studies showed multifocal lesions in 11, renal vein disease in 4, and nodal disease in 2. Only 5 of 22 patients might have had specimen-confined disease (T3a lesion).
Capsular-penetrating (T3a) renal cell carcinoma is not often appreciated preoperatively and is associated frequently with multifocal lesions, renal vein or nodal disease. Frozen section studies to rule out T3a disease at the time of nephron-sparing surgery may help determine which patients need radical surgery.
对于对侧肾功能正常的患者，实施保留肾单位手术的效果存在争议。为了探究可能影响保留肾单位手术成败的危险因素，我们检查了278例因临床局限性肾细胞癌接受根治性肾切除术患者的放射学和病理学报告。
我们整理了参与东部肿瘤协作组方案EST 2886的278例III期肾细胞癌患者的记录中的患者数据，并将术前临床分期与术后病理结果进行比较。如果术前影像学检查表明癌灶为直径5厘米或更小的单极病灶，则这些患者被视为保留肾单位手术的潜在候选者。
在278份根治性肾切除标本中，36份的原发灶直径为5厘米或更小。术前影像学检查显示，36份标本中有14份原本不会被认为适合进行保留肾单位手术。在其余22名潜在候选者中，病理研究显示11例有多灶性病变，4例有肾静脉病变，2例有淋巴结病变。22例患者中只有5例可能存在标本局限型疾病（T3a期病变）。
术前往往难以识别包膜侵犯（T3a期）肾细胞癌，且其常与多灶性病变、肾静脉或淋巴结疾病相关。在保留肾单位手术时进行冰冻切片检查以排除T3a期疾病，可能有助于确定哪些患者需要进行根治性手术。
