| Background:Renal carcinoma is one of the most common malignancies of the urinary system,accounting for 2-3% of adult malignancies.Currently,TNM staging criteria by the American joint committee on cancer are still used in renal carcinoma,in which patients with tumor diameter of 4-7cm are defined as T1 b renal carcinoma.With the development of minimally invasive surgery,laparoscopic surgery has gradually replaced the traditional open surgery and become the main surgical method for the treatment of renal carcinoma,including laparoscopic radical nephrectomy and laparoscopic partial nephrectomy.However,the difference in recurrence and metastasis after laparoscopic radical nephrectomy and laparoscopic partial nephrectomy in T1 b renal cancer are still controversial in domestic and foreign.Circulating tumor cells in peripheral blood are come from primary or secondary tumor site.Circulating tumor cell counts can be changes after surgery,However,the less invasive laparoscopic surgery can be influence the circulating tumor cell counts after surgery of renal carcinoma are still need to discussion.Circulating tumor cells appeared in peripheral blood after surgery,which indicated the possibility of recurrence and metastasis,and the prognosis was not good.However,the peripheral blood circulating tumor cell count will decrease and remain unchanged or increase compared with that before the operation,At the same time,the changes of circulating tumor cells were associated with tumor recurrence and metastasis.Therefore,the recurrence and metastasis and circulating tumor cells after surgery in T1 b renal carcinoma patients who undergoing laparoscopic radical nephrectomy and laparoscopic partial nephrectomy were monitored to understand the postoperative recurrence,metastasis and changes of circulating tumor cells after the two operations,and the relationship between tumor recurrence and metastasis and the changes of circulating tumor cell counts was analyzed.Objective:This study included patients with T1 b renal carcinoma,And we monitor the changes of circulating tumor cells before and after laparoscopic partial nephrectomy and laparoscopic radical nephrectomy.Discuss the effects ofdifferent surgical on circulating tumor cells in renal cancer patients and to analyze the correlation between the changes of circulating tumor cells and prognosis of malignant tumors,and the difference of recurrence and metastasis between the two surgical methods.Methods:We analyzed 148 cases of renal carcinoma from January 2016 to December 2018 in our hospital,including 67 cases of T1 b renal cancer.According to the inclusion criteria,54 cases of T1 b renal carcinoma were included in this study,including 23 cases of laparoscopic partial nephrectomy and 31 cases of laparoscopic radical nephrectomy.Collect clinical data of patients,such as gender,age,contact information,tumor location,surgical method,pathological type,Fuhrman grade,lumbago,and so on.Collect peripheral blood 7.5 ml before surgery and after surgery in 7 days and 3 months.The circulating tumor cell was detected by Subtraction Enrichment-Immunofluorescence in situ hybridization All patients were followed up,and the end point event was tumor recurrence and metastasis or full follow-up of 3 years.The shortest follow-up was 9 months,with an average follow-up of 32.2±6.7months.SPSS22.0 was used for data analysis,and P<0.05 was considered statistically significant.Results:(1)Laparoscopic radical nephrectomy group and laparoscopic partial nephrectomy group showed no statistical difference in recurrence and metastasis,and there was no statistical difference in the number of circulating tumor cells after surgery(P>0.05).(2)There were no difference in the the number of circulating tumor cells detected in the laparoscopic radical nephrectomy group and the laparoscopic partial nephrectomy group in 7 days after surgery(P>0.05),nor in the number of circulating tumor cells detected in 3 months after surgery(P>0.05).(3)Laparoscopic radical nephrectomy group,the number of circulating tumor cell detected in 7 days after surgery were increased compared with preoperative,and showing statistically difference(P<0.05);There was no difference in the number of circulating tumor cells in 3 months after surgery compared withpreoperative(P>0.05).Circulating tumor cells decreased in 3 months after surgery compared with 7 days after surgery,and showing no statistically difference(P>0.05).(4)Laparoscopic partial nephrectomy group,the number of circulating tumor cell detected in 7 days after surgery were increased compared with preoperative,and showing statistically difference(P<0.05);There was no difference in the number of circulating tumor cells in 3 months after surgery compared with preoperative(P>0.05).Circulating tumor cells decreased in 3 months after surgery compared with 7 days after surgery,and showing statistically difference(P<0.05).(5)Laparoscopic radical nephrectomy and laparoscopic partial nephrectomy,the patients with recurrence and metastasis whose circulating tumor cell counts increased in 3 months after surgery compared with before surgeryConclusion:(1)The risk of recurrence and metastasis after partial laparoscopic nephrectomy of T1 b renal carcinoma was not significantly different that compared with laparoscopic radical nephrectomy.(2)In T1 b renal carcinoma,there was no difference in circulating tumor cell counts between laparoscopic partial nephrectomy and laparoscopic radical nephrectomy.(3)In the treatment of T1 b renal carcinoma,the circulating tumor cell counts were increased in laparoscopic partial nephrectomy group and laparoscopic radical nephrectomy group during the short term.the postoperative 3 months circulating tumor cell count recovered to preoperative levels,but laparoscopic partial nephrectomy in the recovery process of circulating tumor cells to remove more apparent.(4)In T1 b renal carcinoma,compared preoperation,the circulating tumor cell counts increased in postoperation are prone to recurrence and metastasis. |
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