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Study on Safe Extension in Nephron Sparing Surgery for Renal Cell Carcinoma 4 cm or Less in Diameter

Author: MengPing
Tutor: WangHe
School: Fourth Military Medical University
Course: Surgery
Keywords: Kidney neoplasms Nephrectomy Nephron sparing surgery Excision extension
CLC: R737.11
Type: Master's thesis
Year: 2007
Downloads: 81
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Abstract


Renal cell carcinoma (RCC) is one of the malignant tumors which is secondary to carcinoma of urinary bladder in the urinary carcinoma.It’s estimated that the morbility of RCC is increased 2% annumly and about 100,000 patients died from this kind of carcinomas every year in the world. About half members of those patients are in their late stage when they were firstly diagnosed of this cancer,about 40% will be recurrenced after and metabasised before radical renal resection,the survival rate is lower than 3% within 3 years who had not received any treatment.RCC has more malignant and insensitivity to radiotherapy and chemotherapy,and immunotherapy is also has little effect on it.Radical nephrectomy has been proven to be an effective choice for cure of localized renal cell carcinoma (RCC).Renal cell carcinoma (RCC) of 4 cm or less is with a low incidence of multicentricity and metastasis and is usually considered suitable for nephron sparing surgery (NSS).Open partial nephrectomy,or nephron sparing surgery (NSS),is now considered the standard of care for the treatment of small renal tumors.The oncologic efficacy and safety of NSS for the treatment of stage - T1a renal tumors has been repeatedly demonstrated to be equivalent to radical nephrectomy.NSS initially was reserved for patients with solitary kidneys,impaired renal function,hereditary tumor syndromes,bilateral renal tumors, and those with significant comorbidities predisposing to future renal failure.The indications have expanded recently to allow elective partial nephrectomy in the setting of a normal contralateral kidney.Furthermore , recent data demonstrate that partial nephrectomy for larger tumors (T1b),which have been historically treated with radical nephrectomy,is a viable option when surgical margins can safely be achieved.Renal cell carcinoma (RCC) of 4 cm or less is with a low incidence of multicentricity and metastasis and is usually considered suitable for nephron sparing surgery (NSS).It is widely accepted that tumor excision with a surrounding margin of normal parenchyma is the safest approach to ensure no residual tumor in the renal remnant. However agreement on the optimal margin in nephron sparing surgery has never been reached.RCC of 4 cm or less was with a lower incidence of multicentricity and NSS in these tumors has showed an excellent long term results compared with those of larger than 4 cm.This pilot study was designed to investigate the distance between extra-pseudocapsule lesions and primary tumors,and to suggest the optimal margin in NSS for RCC 4 cm or less.Objective Renal cell carcinoma (RCC) of 4 cm or less is with a low incidence of multicentricity and metastasis and is usually considered suitable for nephron - sparing surgery (NSS).To explore the excision extension in nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) 4 cm or less in diameter and study Ki-67 and PCNA expression.Methods Forty-one kidneys with RCC 4 cm or less in diameter resected by radical nephrectomy were prospectively studied. The kidney samples were sectioned and examined using immunohistochemistry to observe pathological changes and expressions of Ki - 67 and PCNA in primary tumor and paracarcinoma tissues.Results The diameter of 41 primary tumors was 3.3±0.8cm(range 0.8–4.0cm). Of these,17.0%(7/41) with positive cancer lesions beyond pseudocapsule. Along with the further distance from primary tumor , the proportions of positive expressions of Ki-67 and PCNA in paracarcinoma tissue were decreased gradually. The ratio of strong expression was 57.4% (4/7)in the group with extra-pseudocapsule cancer lesions.Conclusions These data suggest that when NSS is performed in RCC 4 cm or less in diameter,a margin of more than 1 cm of adjacent parenchyma should be excised with the tumor. It is necessary to choice individual treatment for RCC with strong expression of Ki-67 and PCNA.

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CLC: > Medicine, health > Oncology > Genitourinary tumors > Urinary tumors > Kidney,renal pelvis tumor
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