Salvage partial nephrectomy for hereditary renal cancer: Feasibility and outcomes
Salvage partial nephrectomy for hereditary renal cancer: Feasibility and outcomes
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DOI：
10.1016/j.juro.2007.08.150
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发表时间：
2008-01-01
影响因子：
6.6
通讯作者：
Pinto, Peter A.
中科院分区：
文献类型：
--
作者：
Bratslavsky, Gennady;Liu, Jack J.;Pinto, Peter A.
目的：von Hippel-Lindau病患者可能需要重复部分肾切除术，以避免肾脏替代治疗的需要。我们评估了在同一个肾脏上进行第三或第四次肾部分切除术的患者的结局，我们称之为补救性肾部分切除术。材料和方法：我们回顾性分析了1999年至2006年在美国国家癌症研究所接受手术的患者的图表。我们确定了13例施行补救性肾部分切除术的患者中的11例。通过肾保护以及术中和术后并发症评估手术结局。功能结果进行了评估，比较血清肌酐，24小时尿肌酐清除率，和核肾扫描前和后补救性肾部分切除术。结果：所有患者都活着，并没有放射学证据的转移性疾病在中位随访25个月（范围3至83）。13例患者中有6例（46%）发生了严重的围手术期并发症，3例（23%）发生了肾单位丢失。肾单位保存的患者均不需要透析，尽管术后随访时血清肌酐呈上升趋势，肌酐清除率呈下降趋势（p = 0.07和0.08，分别）。结论：虽然补救性肾部分切除术技术要求高，并发症发生率高，但它允许许多患者避免透析。我们相信此经验可作为外科医师及病患考量补救性肾部分切除术之风险与效益时之参考。
Purpose: Patients with von Hippel-Lindau disease may require repeat partial nephrectomies to avoid the need for renal replacement therapy. We evaluated outcomes in patients who underwent third or fourth partial nephrectomies on the same kidney, which we call salvage partial nephrectomy.Materials and Methods: We retrospectively reviewed the charts of patients who underwent surgery at the National Cancer Institute from 1999 to 2006. We identified 11 of 13 patients in whom salvage partial nephrectomy was performed. Surgical outcomes were assessed by renal preservation as well as intraoperative and postoperative complications. Functional outcomes were assessed by comparing serum creatinine, 24-hour urine creatinine clearance, and nuclear renal scan before and after salvage partial nephrectomy.Results: All patients were alive and had no radiographic evidence of metastatic disease at a median followup of 25 months (range 3 to 83). Major perioperative complications occurred in 6 of 13 patients (46%) and loss of a renal unit occurred in 3 (23%). None of the patients in whom renal units were preserved required dialysis, although there was an upward trend in serum creatinine and a downward trend in creatinine clearance at postoperative followup (p = 0.07 and 0.08, respectively).Conclusions: Although salvage partial nephrectomy is technically demanding and it has a high complication rate, it allows many patients to avoid dialysis. We believe that this experience can be used as a reference for surgeons and patients when considering the risks and benefits of salvage partial nephrectomy.