Effect And Observation Of Open Nephron Sparing Surgery And Laparoscopy Nephron Sparing Surgery

OBjective:Currently, the Nephron Sparing Surgery(NSS) has become a better choice for small renal cell carcinoma than Radical Nephrectomy. In particular, the Laparoscopy Nephron Sparing Surgery(LNSS) enjoys increasing clinical advantages. This project is intended to conduct follow-up observations and analyses of the effects of Open Nephron Sparing Surgery(ONSS) and LNSS performed by our hospital.Methods:22 renal carcinoma patients with 0-7cm T1 renal neoplasm, including 14 T1 a patients receiving ONSS and 8 T1 b patients receiving laparoscopy surgery, were selected from those receiving diagnosis and NSS from December 2011 to December 2014 at our hospital. Patients suffering benign renal neoplasm, multiple renal neoplasm, bilateral renal neoplasm, anatomy and functionally solitary kidney, T2-T4 renal neoplasm, or preoperative chronic renal insufficiency were excluded. 12 of these selected patients were males and the others were females, with an average age of 48(32-69 years old) and an average tumor size of 3.6cm(2.1-5.7cm). An outpatient follow-up was carried out every three months for each of these patients, with an average follow-up period of 21 months(6-39 months), in order to observe their double-kidney non-contrast CT scan, abdominal color ultrasound, chest radiography and hepatorenal function.Results:The 22 selected patients all received such examinations as intravenous urography(IVU), CT Angiography(CTA), double-kidney non-contrast + enhanced CT scan, Chest Radiography, electrocardiogram, bladder color ultrasound, blood routine and hepatorenal function. None of the 14 LNSSs was shift to ONSS in the course of the surgery. The warm ischemia time(WIT) of ONSS was 8-20min(average: 14min) and that of LNSS was19-30min(average: 14min); the duration of the surgery was 90-160min(average: 125min),the intraoperative bleeding amount was 80-400ml(average: 160ml), and the postoperative length of stay was 7-10 days(average: 8.7 days). The thickness of carcinoma cutting margin was 5mm. The postoperative pathological report indicated that all cutting margins were negative, 19 of which were clear cell carcinoma, two papillary renal cell carcinoma and one chromophobic cell carcinoma. The patients, after being discharged, received regular immunization therapy with interferon at the outpatient department. As indicated in the results of outpatient follow-up, the hepatorenal function of each of these patients was within normal range, and no tumor recurrence or metastasis was found in abdominal color ultrasound or chest radiography. One patient died of cardiovascular incident nine months after the operation.Conclusions:1.The LNSS has such advantages as tiny wound, fast recovery and short stay in hospital and is easily recognized and understood by the patients, while ONSS is more suitable for patients with large-size carcinoma(T1b) and relatively complicated conditions.ONSS needs only a short warm ischemia time, which can ensure the surgery quality.2.The short- and middle-term follow-up of ONSS and LNSS indicates an excellent disease free survival and a good protection of postoperative renal function. However, the final results can be revealed after five to ten years of follow-up analysis.