腎細胞癌における腎摘除術術式の相違による予後について

Abstract

The primary consideration in surgical approach for renal cell carcinoma must be an adequate exposure, which will enable one to occlude the renal artery and vein at an early stage of the procedure and to remove the renal tumor en bloc with lymphatics. Commonly used approaches in Japan are translumbar (L), transperitoneal (P) and thoracoabdominal ones (Th). Many reports showed that thoracoabdominal approach was an ideal procedure, whereas few paper suggested that transperitoneal approach was superior to translumbar one. Herein we reviewed metastatic rates and survivals as related to type of nephrectomy. During the last 14 years, we treated 193 cases of renal cell carcinoma, of which 118 cases were thought to have received radical nephrectomy. No distant metastasis was found at the time of operation. Surgical approach was translumbar in 52 cases, transperitoneal in 50 and thoracoabdominal in 16. Metastatic rates in one year after nephrectomy were 11.8% (6/51 cases) in L group, 11.6% (5/43 cases) in P group and 28.6% (4/14 cases) in Th group, and 3-year rates were 25.0% (12/48) in L, 14.8% (4/27) in P, 64.3% (9/14) in Th respectively. Three-year relative survival rates were 85.8% in L, 85.0% in P and 67.0% in Th and 5-year relative survival rates were 80.7%, 88.9% and 35.5% respectively. These results seem to show as if the transperitoneal approach is superior to other ones, but statistically there is no significant difference of metastatic and survival rates between P and L. As for the thoracoabdominal approach, no conclusion can be drawn because of adverse factors (tumor weight, stage, etc.) at present time. The average tumor weights were 438 gm. in L, 450 gm in P and 528 gm in Th. The percentage of both pathological stage II and III groups were 10% in L, 22% in P and 50% in Th.