1,临床资料
患者,男性,34岁,因体检发现右肾下极占位一天,门诊拟"右肾癌"收入.入院检查未见有明显阳性体征.入院检查双肾CT提示"右肾下极4*4cm占位,肾癌首先考虑".左肾功能良好.
初步诊断:右肾癌T1N0M0.
2,临床问题
青年男性患者体检发现右肾占位,临床分期T1aN0M0,且肾肿瘤位于肾下极,对侧肾功能正常.本例患者是否可以行保留肾单位手术(NSS)手术
3.文献证据检索
数据文献检索资源:
Cochrane library(www.cochrane.org)
Pubmed-Clinical Queries
中华泌尿外科学会网
检索词:
renal cell carcinoma RCC nephron-sparing surgery NSS 肾癌保留肾单位手术
在Cochrane library(www.cochrane.org)检索到的文献
Title
A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Links Export Central Citation
Comments
Comment in: Eur Urol. 2007 Jun;51(6):1475-6. PMID: 17287074.
Author(s)
Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Marechal JM, Klotz L, Skinner E, Keane T, Claessens I, Sylvester R, European Organization for Research and Treatment of Cancer (EORTC), National Cancer Institute of Canada Clinical Trials Group (NCIC CTG), Southwest Oncology Group (SWOG), Eastern Cooperative Oncology Group (ECOG)
Source
European urology
Date of Publication
2007 Jun
Volume
51
Issue
6
Pages
1606-15
Abstract
OBJECTIVES: This study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (
Medical Subject Headings (MeSH)
Carcinoma, Renal Cell [pathology; *surgery]; Disease Progression; Kidney Neoplasms [pathology; *surgery]; Neoplasm Staging; Nephrectomy [*methods]; Nephrons; *Postoperative Complications; Prospective Studies; Treatment Outcome
MeSH check words
Aged; Female; Humans; Male; Middle Aged
CorrespondenceAddress
Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium. Hendrik.VanPoppel@uz.kuleuven.ac.be
Accession Number
PUBMED 17140723
Cochrane Group Code
SR-PROSTATE
Publication Type
Clinical Trial, Phase III; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
ID
CN-00586285
在PubMed上检索到的文章
Oncological efficacy and safety of nephron-sparing surgery for selected patients with locally advanced renal cell carcinoma
Margulis V, Tamboli P, Jacobsohn KM, Swanson DA, Wood CG.
BJU Int. 2007 Dec;100(6):1235-9.
Which is the real gold standard for small-volume renal tumors Radical nephrectomy versus nephron-sparing surgery
Manikandan R, Srinivasan V, Rané A.
J Endourol. 2004 Feb;18(1):39-44.
在中华医学会泌尿外科网站检索到的文件
肾细胞癌诊治指南(2005试行版)
中华医学会泌尿外科分会
4.证据评价
A 级:大型随机对照试验或Cochrane 系统评价.B 级:小型随机对照试验,半随机对照试验或交叉设计,队列设计,前后对照的试验.C 级:病例2对照试验及横断面试验,非随机对照试验.D 级:描述性研究及专家意见.
A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma.
证据级别:A级(该研究为Cochrane 系统评价)
Oncological efficacy and safety of nephron-sparing surgery for selected patients with locally advanced renal cell carcinoma
证据级别:A级(该研究为Cochrane 系统评价)
Which is the real gold standard for small-volume renal tumors Radical nephrectomy versus nephron-sparing surgery.
证据级别:A级(该研究为Cochrane 系统评价)
肾细胞癌诊治指南(2005试行版)
证据级别:A
五.实施决策
患者是否可以进行NSS手术
根据中华医学会泌尿外科分会的肾细胞癌诊疗指南(2005年试行版)中关于NSS手术的描述提示:NSS适应证:肾癌发生于解剖性或功能性的孤立肾,根治性肾切除术将会导致肾功能不全或尿毒症的患者,如先天性孤立肾,对侧肾功能不全或无功能者,以及双侧肾癌等.
NSS相对适应证:肾癌对侧肾存在某些良性疾病,如肾结石,慢性肾盂肾炎或其他可能导致肾功能恶化的疾病(如高血压,糖尿病,肾动脉窄等)患者.
NSS适应证和相对适应证对肿瘤大小没有具体限定.
NSS可选择适应证:临床分期T1a期(肿瘤≤4cm),肿瘤位于肾脏周边,单发的无症状肾癌,对侧肾功能正常者可选择实施NSS.
本患者的临床病理分期为T1a,属于指南的NSS可选择适应症.
根据A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma 文章中认为对于肾细胞癌直径<4cm的肾细胞癌采用NSS和传统的肾癌根治术可以有同样的近期及远期预后.
Margulis V及Manikandan R 在各自的研究中同样认为对于直径小于4cm的肾细胞肾癌进行NSS是安全,有效的.
根据上述文献检索后认为本例患者可以进行NSS.