科研之友
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摘要
Objectives. To explore the safety and efficacy of mini-margin nephron sparing surgery (NSS) for renal cell carcinoma (RCC) 4ˋcm or less. Methods. Total of 389 cases of RCC 4ˋcm or less with normal contralateral kidneys were included in the study, including 135 cases treated by mini-margin NSS, 98 by 1ˋcm-NSS and 156 by radical nephrectomy (RN). The clinical results were followed-up and comparatively analyzed. Results. The mean and median margin width for mm-NSS was 2.2 and 2.0ˋmm (range 0 to 5). Of them, 112 (83.0%) cases had margins of 3ˋmm or less, and 26 had margins of 0ˋmm (19.3%). The mean width of margin for 1ˋcm-NSS was 11.6ˋmm (median 12, range 10 15). None of the NSS patients had positive surgical margins. The mean follow-up for mm-NSS, 1ˋcm-NSS and RN patients was 69, 82 and 82 months, respectively. Three mm-NSS patients, two 1ˋcm- NSS and four RN patients died of non-cancer related causes. Two mm-NSS patient (1.6%) experienced local recurrence. No distant metastasis was detected in all the patients. The over all 5-year survivals for NSS and RN patients were 100%, 100% and 98.7%, respectively ( ). Conclusions. Mini-margin NSS is as safe and effective as 1ˋcm-NSS and RN in treating early localized RCC 4ˋcm or less. 1. Introduction Nephron sparing surgery (NSS) has proven to be a safe and effective approach for renal cell carcinoma (RCC), with comparable clinical results to radical nephrectomy, especially for the tumors 4ˋcm or less, even in patients with completely normal opposite kidneys. For many years, surgical practice for NSS was to have a more than 1ˋcm margin of normal tissue around the tumor [1, 2]. However, more recent studies show that the width of the margin seems not important. NSS with a smaller margin is as well safe and effective in tumor control [3]. And even pure enucleation is as effective as partial nephrectomy with a rim of healthy parenchyma [4]. From January 1998 to December 2008, based on the previous studies in our institute, 135 cases of RCC 4ˋcm or less in diameter and staged as T1aN0M0 with normal contralateral kidney were treated with 5ˋmm mini-margin NSS (mm-NSS). The clinical results were followed and compared with 99 cases of NSS with margin 1ˋcm or more (1ˋcm-NSS) and 156 cases of radical nephrectomy (RN) for RCC of same stage. The Data were comparatively analyzed to evaluate the safety and efficacy of mini-margin NSS in treating early localized RCC 4ˋcm or less. 2. Materials And Methods 2.1. Patient Selection Only patients with RCC 4ˋcm or less, with normal contralateral kidney, without lymph node or distant
