Nissenkorn I, Bernheim J
Department of Urology, Meir General Hospital, Kfar Saba, Tel-Aviv, Israel.
J Urol. 1995 Mar;153(3 Pt 1):620-2. doi: 10.1097/00005392-199503000-00018.
In the era of ultrasound and computerized tomography, when more than 50% of renal cell carcinomas are detected incidently, with a high proportion of small tumors, the standard treatment of radical nephrectomy in the presence of a normal contralateral kidney should be questioned. The main objection against conservative surgery for renal cell carcinoma has been the concern about satellite small renal cell carcinomas, which have been reported in 7% and 19.7% of 100 and 66 kidneys, respectively. We studied the incidence of multicentric neoplasms in 50 kidneys: 27 with renal cell carcinoma and 23 autopsied normal kidneys. The incidence of small renal cell carcinoma in the kidneys with a tumor was 11.1% and that of small nodules in normal autopsied kidneys was 13% (none of them was malignant). The incidence of satellite malignant nodules in patients with renal cell carcinoma 3 cm. or smaller was 3.7% in our series, and 0% and 3% in other series. Therefore, patients who undergo nephrectomy for tumors up to 3 cm. in diameter may be considered as overtreated in 96 to 100% of the cases. We conclude cautiously that partial nephrectomy should be widely accepted in patients with small renal carcinoma and in the presence of a normal contralateral kidney.
在超声和计算机断层扫描时代，超过50%的肾细胞癌是偶然发现的，其中小肿瘤比例很高，对于对侧肾脏正常情况下进行根治性肾切除术的标准治疗方法应受到质疑。反对肾细胞癌保守手术的主要原因一直是担心存在卫星型小肾细胞癌，在100例和66例肾脏中，分别有7%和19.7%报告有此类情况。我们研究了50个肾脏中多中心肿瘤的发生率：27个患有肾细胞癌，23个为尸检正常的肾脏。有肿瘤的肾脏中小肾细胞癌的发生率为11.1%，尸检正常肾脏中小结节的发生率为13%（均无恶性）。在我们的系列研究中，直径3厘米或更小的肾细胞癌患者中卫星型恶性结节的发生率为3.7%，在其他系列中分别为0%和3%。因此，因直径达3厘米的肿瘤而接受肾切除术的患者，在96%至100%的病例中可能被视为过度治疗。我们谨慎地得出结论，对于小肾癌且对侧肾脏正常的患者，应广泛接受部分肾切除术。
