Treatment of renal cell carcinoma: A single center clinical analysis (1995-2009) / 第二军医大学学报

ABSTRACT

To summarize the clinical data of renal cell carcinoma (RCC) in our hospital in the past 15 years, and to investigate the mini-invasive rate, resection rate and safety of surgical treatment for RCC. Methods We retrospectively analyzed the clinical data of 2,052 consecutive cases with renal tumors during Jan. 1995 to Nov. 2009. The patients were divided into 3 groups according to the time they were treated. The 1st group from Jan. 1995 to Dec. 1999; the 2nd group from Jan. 2000 to Dec. 2004; and the 3rd group from Jan. 2005 to Nov. 2009. The operation method, resection rate and safety were compared between different groups. Results Among 2,052 patients, 1,516 had T1 stage RCC; 536 cases had T2-4 stage RCC, including 277 with locally advanced RCC (lymphatic metastasis, venous tumor thrombus, resectable local invasion, solitary hepatic or lung metastasis); 217 cases received radical nephrectomy, 41 received palliative surgery, and the surgical procedures were not finished in 19 cases (including 3died during operation due to cancer embolus defluxion). All the 546 patients in the 1st group received open surgery, including 42 receiving nephron-sparing surgery; for 89 cases with locally advanced RCC, radical nephrectomy was done in 64 cases, palliative surgery in 16 cases, and surgery procedures were not finished in 9 cases (including 2 died during operation due to cancer embolus delluxion). Of the 673 cases in the 2nd group, 556 cases received open surgeries, including 95 receiving nephron-sparing surgery and 117 received laparoscopic surgery (via lumbar dank approach); for the 88 cases with locally advanced RCC, radical nephrectomy was done in 68 cases, palliative surgery in 13 cases, and surgery procedures were not finished in 7 cases (including 1 died during operation due to cancer embolus defluxion). Of the 833 cases in the 3rd group, 248 received open surgery, including 142 cases receiving nephron-sparing surgery and 585 received laparoscopic surgeries; 100 cases had locally advanced RCC, and 85 of them received radical nephrectomy, 12 received palliative surgery, and surgical procedures were not finished in 3 cases, with no death cases during the perioperative period. Conclusion Minimally invasive surgery has become the dominant approach for treatment for renal cell carcinoma owning to fast development of laparoscopy. Improvement in surgical technique has promoted the safety and resectable rate of locally advanced RCC, and nephron-spaeing surgery has been more widely used and has gradually been done in a minimally invasive manner. Single-port laparoscopic surgery is gaining increaeing attention in treatment of RCC.