Positive surgical parenchymal margin after laparoscopic partial nephrectomy for renal cell carcinoma: Oncological outcomes
Positive surgical parenchymal margin after laparoscopic partial nephrectomy for renal cell carcinoma: Oncological outcomes
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DOI：
10.1016/j.juro.2006.08.008
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发表时间：
2006-12-01
影响因子：
6.6
通讯作者：
Kavoussi, Louis R.
中科院分区：
文献类型：
--
作者：
Permpongkosol, Sompol;Colombo, Jose R., Jr.;Kavoussi, Louis R.
目的：肾部分切除术的肿瘤疗效与术中获得阴性切缘有关。本研究评估了接受腹腔镜部分肾切除术的肾肿瘤患者的肿瘤预后，这些患者的最终病理结果为手术切缘阳性。材料与方法：回顾2位外科医生对511例病理诊断为肾细胞癌的患者行腹腔镜肾部分切除术的经验。对手术切缘阳性的患者进行回顾性鉴定。随访5年，每6至12个月进行一次胸部x线和计算机断层扫描，评估肿瘤预后。结果：9例（1.8%）患者最终病理呈阳性。平均肿瘤大小为2.8 cm（范围1.7 ~ 4.0）。2例患者接受了二次完全根治性肾切除术，1例在腹腔镜部分肾切除术后4天，另1例在2个月。两例患者均未在肾切除标本中发现残留肿瘤。在其余7例选择监测的患者中，1例患有von Hippel-Lindau病，在腹腔镜部分肾切除术后10个月死于转移性肾细胞癌至胰腺。其余患者在中位随访32个月（6至76个月）期间无疾病。该系列患者均未行左端播种术。结论：腹腔镜肾部分切除术后切缘呈阳性不一定表明残留病变。然而，警惕的监控是强制性的。虽然中期预后与阴性切缘患者相似，但需要更长的随访时间来确定该亚组患者的最终肿瘤预后。
Purpose: The oncological efficacy of partial nephrectomy is related to obtaining a negative surgical margin intraoperatively. This study assesses the oncological outcomes of patients undergoing laparoscopic partial nephrectomy for a renal tumor who had positive surgical margin on final pathology.Materials and Methods: The experiences of 2 surgeons with 511 patients with a pathological diagnosis of renal cell carcinoma treated with laparoscopic partial nephrectomy were reviewed. Patients with a positive surgical margin were identified retrospectively. Oncological outcomes were assessed by followup with chest x-ray and computerized tomography every 6 to 12 months for 5 years.Results: There were 9 patients (1.8%) with a positive margin on final pathology. Mean tumor size was 2.8 cm (range 1.7 to 4.0). Two patients underwent secondary completion radical nephrectomy, one at 4 days and the other at 2 months following laparoscopic partial nephrectomy. No residual tumor was identified in the nephrectomy specimen in either patient. Of the remaining 7 patients who elected surveillance, 1 with von Hippel-Lindau disease died of metastatic renal cell carcinoma to pancreas 10 months after laparoscopic partial nephrectomy. The remaining patients were disease-free for a median followup of 32 months (range 6 to 76). No patient in the series had port site seeding.Conclusions: A positive margin following laparoscopic partial nephrectomy does not necessarily indicate residual disease. However, vigilant monitoring is mandatory. While midterm outcomes parallel those of patients with a negative margin, longer followup is necessary to determine the ultimate oncological outcomes in this subgroup of patients.