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[Nephron-sparing surgery for small renal cell carcinoma: clinical analysis of 21 cases]
Yao-Jun Xiao1, Shao-Bin Zheng, Wan-Long Tan
1Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. xyj@9882002@sina.com
Objective:
To evaluate the clinical effects of nephron-sparing surgery in patients with early-stage small renal cell carcinoma.
Methods:
Nephron-sparing surgery was performed in 21 patients with renal cell carcinoma including 1 with solitary kidney, 3 with unilateral tumor and contralateral renal compromise, and 17 with unilateral tumor and normal contralateral kidney. The diameter of the tumors ranged from 1.5 to 6.0 cm, with a mean of 2.8 cm. The tumor diameter in 17 patients with normal contralateral kidney was less than 4 cm (mean 2.5 cm) and the average diameter in 4 patients with contralateral renal compromise was 4.2 cm. Sixteen cases were in stage T(1), 4 in stage T(2), and 1 in stage T(3). Of the 21 patients, 4 underwent tumor enucleation, 10 polar nephrectomy and 7 wedge resection.
Results:
All patients were followed up for an average of 40.8 months (7 to 66 months). One patient suffered a right lung and mediastinum metastasis 3 years after the surgery later and 1 with chronic glomerulonephritis required dialysis 27 months after the operation. No surgical complication or local recurrence were found in other patients.
Conclusion:
As a safe and effective therapy for early-stage small renal cell carcinoma, nephron-sparing surgery can be considered as the gold-standard therapy for patients with lesions less than 4 cm in T(1) and T(2) stages of localized unilateral tumor with normal contralateral kidney.
Insights
Nephron-sparing surgery is a safe and effective treatment for early-stage small renal cell carcinoma. This approach is considered the gold standard for localized tumors under 4 cm.
Area of Science:
- Urology
- Oncology
- Nephrology
Context:
- Early-stage small renal cell carcinoma presents unique treatment challenges.
- Nephron-sparing surgery aims to preserve renal function while removing tumors.
- Patient selection is crucial for successful outcomes in renal cell carcinoma treatment.
Purpose:
- To evaluate the clinical outcomes of nephron-sparing surgery for early-stage small renal cell carcinoma.
- To assess the safety and efficacy of nephron-sparing surgery in diverse patient subgroups.
- To determine the long-term oncological control and renal function preservation after nephron-sparing surgery.
Summary:
- Nephron-sparing surgery was performed on 21 patients with early-stage renal cell carcinoma, including those with solitary kidneys or compromised contralateral kidneys.
- Tumor sizes ranged from 1.5 to 6.0 cm (mean 2.8 cm), with most tumors under 4 cm.
- Follow-up averaged 40.8 months, showing no local recurrence or surgical complications in most patients, though one developed metastasis and another required dialysis.
Impact:
- Nephron-sparing surgery demonstrates favorable oncological control and renal function preservation.
- This technique offers a safe and effective alternative to radical nephrectomy for selected renal cell carcinoma patients.
- The findings support nephron-sparing surgery as a gold-standard treatment for localized renal tumors under 4 cm.
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