Partial nephrectomy for selected renal cortical tumours of ≥ 7 cm.
Partial nephrectomy for selected renal cortical tumours of ≥ 7 cm.
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DOI：
10.1111/j.1464-410x.2010.09405.x
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发表时间：
2010-11
影响因子：
4.5
通讯作者：
Russo P
中科院分区：
文献类型：
--
作者：
Karellas ME;O'Brien MF;Jang TL;Bernstein M;Russo P
检查我们在接受肾部分切除术（PN）治疗≥7 cm肾皮质肿瘤（RCT）患者中的机构经验，因为PN是<7 cm适当RCT的公认手术方法，但关于PN用于较大肿瘤的数据有限。在机构审查委员会批准后，我们检查了前瞻性收集的1989年至2008年期间接受PN治疗的≥7 cm RCT患者的手术数据库。相关的人口统计学，临床，手术和病理资料进行了审查。总共确定了34例患者（37个肾脏单位）进行分析，中位（四分位距，IQR）年龄为63（52-71）岁，中位（IQR）肿瘤大小为7.5（7.2-9.0）cm，最大肿瘤为19 cm。在31个肾单位（28例患者，84%）中，癌是明显的，其中16个肾单位（43%）有传统的透明细胞癌，其次是乳头状肾单位（21%）。目前，这28例患者中有20例（71%）无疾病，3例患有转移性疾病（2例术前已知有转移性疾病），3例死于疾病，2例死于其他原因。术前估计肾小球滤过率中位数（IQR）为65（55-73）mL/min/1.73 m2，PN后为55（47-74）mL/min/1.73 m2（P = 0.003，配对Student t检验）。我们的研究结果表明，对于≥7 cm的RCT，可以安全地进行PN，并为选定的患者提供有效的肿瘤控制。对于患有适当肿瘤、孤立肾或既存肾功能不全的患者，应考虑PN。
To examine our institutional experience in patients treated with partial nephrectomy (PN) for renal cortical tumours (RCTs) of ≥7 cm, as PN is an accepted surgical approach for appropriate RCTs of <7 cm but there are limited data on the use of PN for larger tumours. After Institutional Review Board approval, we examined our prospectively collected surgical database for patients treated with PN for RCTs of ≥7 cm between 1989 and 2008. Pertinent demographic, clinical, surgical and pathological data were reviewed. In all, 34 patients (37 renal units) were identified for analysis with a median (interquartile range, IQR) age of 63 (52-71) years, median (IQR) tumour size of 7.5 (7.2-9.0) cm with the largest tumour being 19 cm. In 31 renal units (28 patients, 84%) carcinoma was evident, with 16 renal units (43%) having conventional clear cell carcinoma, followed by papillary in eight renal units (21%). Currently, 20 of these 28 patients (71%) are disease free, three are alive with metastatic disease (two had known preoperative metastatic disease), three died from disease and two died from other causes. The median (IQR) preoperative estimated glomerular filtration rate was 65 (55-73) mL/min/1.73 m2, compared with 55 (47-74) mL/min/1.73 m2 after PN (P = 0.003, paired Student's t-test). Our findings suggest that PN for RCTs of ≥7 cm can be safely performed and provide effective tumour control for selected patients. PN should be considered for patients with appropriate tumours, solitary kidneys or pre-existing renal insufficiency.