Partial nephrectomy for small localized renal cell carcinoma

Abstract

著者らの施設において1992年から2001年までに腎細胞癌に対し, 腎部分切除術を施行した54症例(絶対的適応患者11名, 選択的適応患者43名, 観察期間・中央値44ヵ月)の臨床的検討を行った.根治的腎摘除術を施行した症例のうち, 臨床病期Tlaの51症例を比較対象として, 周術期合併症, 手術前後の腎機能, 再発率について調べた結果, 術中の出血量は部分切除群の方が多いものの, 同種血輸血の割合に関して差は認めなかった.両群には, 病理学的所見, 合併症に関して有意差はなかった.また部分切除術後, 2症例に尿瘻, 1症例に腎性高血圧を認めた.部分切除術後の局所再発は認められず, 5年非再発率に関しても両群に有意差を認なかった.術後の腎機能は両群とも安定していたが, 根治的腎摘除後では, 基礎疾患を有する2症例(糖尿病, 腹部動脈瘤術後)において徐々に腎機能低下を示していた.以上より, 小径腎細胞癌に対する腎部分切除術は, 根治的腎摘除術と比較しても, 安全で有用な治療法と示唆された

We retrospectively reviewed the records of 54 patients with RCC who underwent partial nephrectomy for the primary lesion between 1992 and 2001. The indications for partial nephrectomy were elective in 43 and imperative in 11 patients. We selected 51 patients with clinical stage T1a who underwent open radical nephrectomy for localized RCC for comparison during the same period. We evaluated the peri- and postoperative complications, disease-free survival rates and changes of renal function in the partial nephrectomy (PN) group, compared to the radical nephrectomy (RN) group. There was no significant difference with regard to pathological findings and clinical outcomes between two groups, except for the amount of intraoperative bleeding. Three patients in the PN group developed postoperative complications, consisting of urine leakage in 2 patients and renal hypertension in 1 patient. The 5-year disease-free survival rates in the PN and RN groups were 90% and 97%, respectively. Local recurrence from the resected area of the renal parenchyma was not found in patients in the PN group. All patients in the PN group maintained satisfactory and stable renal function. In the RN group, renal function slowly deteriorated in 2 patients. Therefore, partial nephrectomy offers cancer control and an acceptable low mortality rate, comparable to those of radical nephrectomy.