Butler B P, Novick A C, Miller D P, Campbell S A, Licht M R
Department of Urology, Cleveland Clinic Foundation, Ohio, USA.
Urology. 1995 Jan;45(1):34-40; discussion 40-1. doi: 10.1016/s0090-4295(95)96306-5.
There is controversy concerning the management of small unilateral renal cell carcinomas. The present study was undertaken to evaluate the relative efficacy of radical nephrectomy versus nephron-sparing surgery in such patients.
Patients with a single, small (less than 4 cm), localized, unilateral, sporadic renal cell carcinoma (RCC) were identified from an institutional registry. From 1975 to 1992, 88 patients fulfilling these criteria were treated with either radical nephrectomy (n = 42) or nephron-sparing surgery (n = 46). The mean postoperative follow-up interval is 48 +/- 29 months.
The radical and nephron-sparing surgical groups were well matched for patient age, sex, renal function, diabetes, hypertension, tumor size, tumor location, and tumor stage. All patients in both groups had low pathologic stage RCC. There was no difference between the two groups in terms of the mean hospital stay, the requirement for blood transfusions, or the occurrence of surgical complications. There was no difference in the mean preoperative and postoperative serum creatinine levels for patients in the nephron-sparing surgery group. However, the mean postoperative serum creatinine levels were significantly higher than the mean preoperative levels for patients in the radical nephrectomy group (P < 0.001). A single patient in each group developed recurrent RCC postoperatively. The cancer-specific 5-year survival rate for patients in the radical and nephron-sparing surgical groups is 97% and 100%, respectively.
Radical nephrectomy and nephron-sparing surgery each provide safe and effective curative treatment for patients with a single, small, unilateral localized RCC. The long-term renal functional advantage of nephron-sparing surgery in this setting is not established.
对于小的单侧肾细胞癌的治疗存在争议。本研究旨在评估根治性肾切除术与保留肾单位手术对此类患者的相对疗效。
从机构登记处识别出患有单个、小（小于4厘米）、局限性、单侧、散发性肾细胞癌（RCC）的患者。1975年至1992年，88例符合这些标准的患者接受了根治性肾切除术（n = 42）或保留肾单位手术（n = 46）。术后平均随访间隔为48±29个月。
根治性手术组和保留肾单位手术组在患者年龄、性别、肾功能、糖尿病、高血压、肿瘤大小、肿瘤位置和肿瘤分期方面匹配良好。两组所有患者的病理分期均为低分期RCC。两组在平均住院时间、输血需求或手术并发症发生率方面无差异。保留肾单位手术组患者术前和术后血清肌酐水平均值无差异。然而，根治性肾切除术组患者术后血清肌酐水平均值显著高于术前水平（P < 0.001）。每组各有1例患者术后出现复发性RCC。根治性手术组和保留肾单位手术组患者的癌症特异性5年生存率分别为97%和100%。
根治性肾切除术和保留肾单位手术均为单个、小、单侧局限性RCC患者提供了安全有效的治愈性治疗。在这种情况下，保留肾单位手术的长期肾功能优势尚未确立。
