| Objective: The oncologic safety of Nephron-sparing surgery (NSS) for smallrenal masses replacing radical nephrectomy (RN) has been recognized, less than4cm early localized renal tumors underwent NSS has become the gold standard forelective NSS. The development of medical imaging technology，popularization ofhealth examination，and obviously higher detection rate of early renal cell carcinoma，promote the clinical application of elective NSS. With the development of laparoscopicinstruments and the improvement of experience and technology of the operator,clinical application of laparoscopic NSS is safe. The aim of this study is to comparethe efficacy of laparoscopic selectivity NSS and RN in the treatment of early stagerenal cell carcinoma and observation the long-term renal function.Methods: Reviewing and summarizing from March2007to June2012, therewere113patients with early renal cell carcinoma，who were treated by multi centerselective laparoscopic urological surgery. According to the different modes ofoperation, these113cases was divided into elective laparoscopic nephron-sparingsurgery (LNSS) group and Laparoscopic radical nephrectomy (LRN) group. We putthe LNSS group as treatment group,the LRN group as control group. Both two groupswere unilateral renal tumor,and contralateral kidneys are normal. There were45cases of treatment group, which belong to phase T1a68cases of control groupinclude phase T1a63cases and phase T1b5cases. We compared age, tumor size,tumor stage, pathological type, operation time, intraoperative bleeding volume,postoperative drainage, postoperative hospital stay, complications related to operation,before and after the operation of hemoglobin (Hb), renal function (serum Cr),recurrence and survival status of the two groups.Results: All patients were successfully treated with operation, the two groups hadno postoperative bleeding, urinary leakage, pulmonary embolism, deep veinthrombosis complications and no peri operation period death cases. Throughobservation, the age, tumor size and pathological type had no obvious difference(P＞0.05). In the treatment group, the tendency of postoperative drainage volume and hospitalization time was slightly higher than the control group, but the differenceswere not significant(P＞0.05). Operation time, and intraoperative bleeding volumewere significantly more than those in the control group, there was significantdifference (P＜0.05), but no significant difference compared with postoperative Hb.With no significant difference between the two groups before treatment Hb, and serumCr contrast (P＞0.05), Hb of the two groups were reduced after treatment, andcomparison among groups had no significant difference (P＞0.05). While in thecontrol group, after treatment serum Cr significantly increased, and15（22.1%）caseshad acute renal insufficiency of evidence. Compared with the mean blood Cr, therewas significant difference of the two groups (P＜0.05). During the follow-up of3months, the average time of follow-up was47.66±6.2months in the treatment group,with no patients with abnormal renal function, and3（6.67%） patients died of cardiocerebral vascular disease and other reasons, during follow-up; The average time offollow-up was46.24±5.2months in the control group, and9（13.23%） cases hadrenal insufficiency signs, without dialysis treatment, and6（8.82%） cases died ofcardio cerebral vascular disease and other reasons. During the follow-up period, thetwo groups had no local recurrence cases and cancer specific death patients.Conclusion: In the laparoscopic technique feasibility condition, NSS underlaparoscopy is safe for patients with less than4cm of early localized renal cellcarcinoma. Compared with LRN, the long-term curative effect of LNSS for thetreatment of renal cell carcinoma and tumor had no significant differences, butpatients with postoperative renal function recovered faster and obtained goodlong-term effect of renal function. |
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