Objective. The aim of our study was to compare long-term oncological outcomes following nephron-sparing surgery (NSS) and radical nephrectomy (RN) for renal cell carcinoma (RCC) 4 to 7 cm in diameter. Material and Methods. The study included patients who underwent RN or NSS for RCC 4 to 7 cm in diameter between 1998 and 2009. The studied groups were compared with respect to the patients’ age, sex, physical status according to the American Society of Anesthesiologists Physical classification, histological type, stage, tumor size, grade, duration of the operation, and complications. Survival was established using the Kaplan-Meier method. The risk factors for survival were analyzed using a multivariate Cox regression model. Results. During the study, 351 patients underwent surgery: 317 patients (90.3%) underwent RN, and 34 (9.7%), NSS. The compared groups differed with respect to tumor size (P=0.001) and stage (P=0.006). The overall estimated 12-year survival was 53.7% after RN and 55.2% after NSS (log-rank test P=0.437). The 12-year cancer-specific survival in the RN and NSS groups was 69.6% and 80.6%, respectively (log-rank test P=0.198). Pathological stage and patients’ age were the major factors affecting both overall and cancer-specific survival. The type of surgery (NSS or RN) had no effect on survival. Conclusions. Our study showed that nephron-sparing surgery is a safe technique compared with radical nephrectomy that ensures good oncological control in the treatment of renal cell carcinoma measuring 4 to 7 cm and may be proposed as the treatment of choice for renal tumors not only up to 4 cm, but also 4 to 7 cm in size.
The D'Amico criteria may underestimate potentially aggressive prostate cancer in up to 37.5% of patients. Consequently, caution is recommended when the decision concerning the treatment modality is based on D'Amico criteria alone.
Šis klinikinis atvejis iliustruoja vezikorektalinės fistulės sėkmingą gydymą ir baigtį, pirmą kartą atlikus abipusę laparoskopinę retroperitoninę ureterokutaneostomiją. Vezikorektalinės fistulės yra vienos iš retų, tačiau bene labiausiai pacientų gyvenimo kokybę veikiančių ligų, kurios neretai išsivysto po mažojo dubens organų vėžio kompleksinio gydymo ar lokaliai progresuojant navikiniam procesui. Tai vienos labiausiai žmogų luošinančių komplikacijų, kurių gydymas turi būti individualizuotas, reikalauja didelės skirtingų specialistų komandos patirties, tačiau neretai būna pavėluotas ir lydimas dažno ligos atsinaujinimo. Dėl progresuojančio onkologinio proceso ar anksčiau taikytų gydymo metodų (spindulinio, chirurginio gydymo) dažnai yra negalimos sudėtingos operacijos. Tokiu atveju gydymo sėkmę lemia pasirinkta nauja, mažiau invazyvi gydymo metodika. Šis klinikinis atvejis iliustruoja sėkmingą vezikorektalinės fistulės gydymą ir baigtį, pirmą kartą atlikus abipusę laparoskopinę retroperitoninę ureterokutaneostomiją.
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