Surgical management of renal tumors 4 cm. or less in a contemporary cohort
Surgical management of renal tumors 4 cm. or less in a contemporary cohort
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DOI：
10.1016/s0022-5347(05)67793-2
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发表时间：
2000-03-01
影响因子：
6.6
通讯作者：
Russo, P
中科院分区：
文献类型：
--
作者：
Lee, CT;Katz, J;Russo, P
目的：我们评估了一个肾肿瘤> 4 cm的患者队列。或更少治疗部分或根治性肾切除术。我们比较了患者和肿瘤的特点，生存在这2 groups.Materials和方法：我们回顾性分析了670例患者的中位年龄为63岁，1989年7月31日和1997年7月31日之间的肾细胞癌手术治疗的记录。肾肿瘤4.0 cm。252例（38%）患者共接受了262次手术，其中包括183例（70%）根治性肾切除术和79例（30%）部分肾切除术。10名患者因双侧肾细胞癌各需要2次手术。中位随访时间为40个月。我们使用卡方或Wilcoxon分析比较了部分和根治性肾切除术组的临床病理参数。生存分析采用logrank检验和考克斯回归模型。结果：肾部分切除组和根治性切除组在性别比例、肿瘤表现、组织学分类、病理分期和并发症发生率方面具有可比性。中位肿瘤大小为2.5和3.0 cm。肾部分切除术组和根治性肾切除术组分别为（p = 0.0001）。肾部分切除术组1例（1.3%）切除不完全，根治性肾切除术组0例。两种手术后均无局部复发，疾病特异性、无病生存率和总生存率无显著差异（p = 0.98，0.23和0.20，分别）。结论：无论采用部分或根治性肾切除术治疗，肾小肿瘤患者的围手术期发病率、病理分期和结局相似。因此，肾部分切除术仍然是一个安全的替代肿瘤的这种大小。
Purpose: We evaluated a patient cohort with renal tumors 4 cm. or less treated with partial or radical nephrectomy. We compared patient and tumor characteristics, and survival in these 2 groups.Materials and Methods: We retrospectively analyzed the records of 670 patients with a median age of 63 years treated surgically for renal cell carcinoma between July 31, 1989 and July 31, 1997. Renal tumors 4.0 cm. or less were noted in 252 patients (38%) who underwent a total of 262 procedures, including 183 radical (70%) and 79 partial (30%) nephrectomies. Ten patients required 2 operations each because of bilateral renal cell carcinoma. Median followup was 40 months. We compared clinicopathological parameters in the partial and radical nephrectomy groups using chi-square or Wilcoxon analysis as appropriate. Survival analysis was determined by the log rank test and Cox regression model.Results: The partial and radical nephrectomy groups were comparable with respect to gender ratio, tumor presentation, histological classification, pathological stage and complication rate. Median tumor size was 2.5 and 3.0 cm. in the partial and radical nephrectomy groups, respectively (p = 0.0001). Resection was incomplete in 1 patient (1.3%) in the partial and none in the radical nephrectomy group. There was no local recurrence after either procedure, and no significant difference in disease specific, disease-free and overall survival (p = 0.98, 0.23 and 0.20, respectively).Conclusions: Patients with a small renal tumor have similar perioperative morbidity, pathological stage and outcome regardless of treatment with partial or radical nephrectomy. Therefore, partial nephrectomy remains a safe alternative for tumors of this size.