Buizza C, Antonelli D, Chisena S, Bernasconi S, Zaroli A, Belloni M, Mandressi A
Unità Operativa di Urologia, Ospedale di Busto Arisizio, VA.
Arch Ital Urol Androl. 1997 Apr;69(2):93-100.
Due to the increasing use of sophisticated imaging techniques, up to 30% of diagnosed renal cell carcinoma (RCC) are asymptomatic and diagnosed incidentally. Getting the cue from our personal survey of conservative renal surgery for renal cell carcinoma with a cancer specific survival of 95.5% after a mean follow up of 32.7 months, a review of the literature is illustrated: numerous studies have documented the technical success rate with this approach as well as long term disease free survival, comparable to that obtained by radical nephrectomy, in patients with unilateral, small, low stage tumors and normal opposite kidney. Patient selection is of extreme importance in case of partial resection in the presence of a normal contralateral kidney. The tumor must be < 3-4 cm, solitary, well delineated on CT, without invasion of the perinephric far or pyelocaliceal system (T1 and T2), easily resectable with at least 1 cm of healthy parenchyma. Only well informed patients who agree on a careful follow up after surgery can be candidates for kidney sparing surgery. In case of imperative surgery the follow up must be strict and personified for every single patient. Those patients who underwent a partial nephrectomy in presence of a normal contralateral kidney should be monitored with a conventional follow up monitored in order to detect an eventual local recurrence: 12 monthly ultrasonography and contrast enhanced CT scan alternately every 6 months for the first five years after surgery and then lifelong once a year by echography and/or CT scan.
由于先进成像技术的使用日益增加，高达30%的确诊肾细胞癌（RCC）是无症状的，而是偶然发现的。根据我们对肾细胞癌保守性肾手术的个人调查提示，平均随访32.7个月后癌症特异性生存率为95.5%，现对文献进行综述：众多研究记录了这种方法的技术成功率以及长期无病生存率，对于单侧、小的、低分期肿瘤且对侧肾脏正常的患者，其与根治性肾切除术的结果相当。在对侧肾脏正常的情况下进行部分切除时，患者选择至关重要。肿瘤必须<3 - 4厘米，孤立，在CT上界限清晰，未侵犯肾周脂肪或肾盂肾盏系统（T1和T2），易于切除且至少有1厘米的健康实质。只有充分知情并同意术后进行仔细随访的患者才可能成为保留肾手术的候选者。在必须进行手术的情况下，随访必须严格且针对每个患者个体化。那些对侧肾脏正常时接受了部分肾切除术的患者应通过常规随访进行监测，以便发现可能的局部复发：术后前五年，每12个月进行超声检查，每6个月交替进行增强CT扫描，然后终身每年进行一次超声检查和/或CT扫描。
