Danuser H, Studer U E, Zingg E J
Urologische Universitätsklinik, Inselspital Bern.
Schweiz Med Wochenschr. 1993 Jul 3;123(26):1337-43.
In 18 patients with renal cell carcinoma in anatomical or functional single kidneys, with limited renal function or bilateral tumors, partial renal resection was absolutely indicated to preserve renal function. In 17 patients with small peripheral tumors and intact contralateral kidney, partial renal resection was performed electively. One patient of each group died during postoperative care. During follow-up, 4 patients with absolute indication for partial renal resection showed progression of the disease. Three developed distant metastases, and in one patient local relapse with infiltration of the inferior cava vein occurred. These 4 patients had had a bilateral synchronous or asynchronous stage pT2 or pT3 renal cell carcinoma and died from the neoplasm within 10-36 months postoperatively. 13 of 18 patients with absolute indication remained tumorfree during a median follow-up period of 57 months. Partial renal resection saved 15 of these 17 patients from dialysis. Sixteen of 17 patients in whom partial renal resection was performed electively remained tumorfree during a median follow-up period of 28 months. The results suggest that, given an absolute indication to prevent dialysis, partial renal resection should be performed whenever technically possible. In patients with small peripherally located tumors and intact contralateral kidney, partial renal resection as an elective procedure must be considered a genuine alternative to radical nephrectomy.
在18例解剖学或功能上为单肾、肾功能有限或双侧肿瘤的肾细胞癌患者中，为保留肾功能绝对需要进行部分肾切除术。在17例患有小的周围型肿瘤且对侧肾完整的患者中，选择性地进行了部分肾切除术。每组各有1例患者在术后护理期间死亡。在随访期间，4例有部分肾切除术绝对指征的患者出现疾病进展。3例发生远处转移，1例出现局部复发并侵犯下腔静脉。这4例患者患有双侧同步或异时性pT2或pT3期肾细胞癌，术后10 - 36个月内因肿瘤死亡。18例有绝对指征的患者中有13例在中位随访期57个月内无肿瘤复发。部分肾切除术使这17例患者中的15例免于透析。17例选择性进行部分肾切除术的患者中有16例在中位随访期28个月内无肿瘤复发。结果表明，鉴于有预防透析的绝对指征，只要技术上可行，就应进行部分肾切除术。对于患有小的周围型肿瘤且对侧肾完整的患者，选择性进行部分肾切除术必须被视为根治性肾切除术的真正替代方案。
