%0 Journal Article
%T Mini-Margin Nephron Sparing Surgery for Renal Cell Carcinoma 4£¿cm or Less
%A Quanlin Li
%A Hongwei Guan
%A Jie Qin
%A Tao Jiang
%J Advances in Urology
%D 2010
%I Hindawi Publishing Corporation
%R 10.1155/2010/145942
%X Objectives. To explore the safety and efficacy of mini-margin nephron sparing surgery (NSS) for renal cell carcinoma (RCC) 4£¿cm or less. Methods. Total of 389 cases of RCC 4£¿cm or less with normal contralateral kidneys were included in the study, including 135 cases treated by mini-margin NSS, 98 by 1£¿cm-NSS and 156 by radical nephrectomy (RN). The clinical results were followed-up and comparatively analyzed. Results. The mean and median margin width for mm-NSS was 2.2 and 2.0£¿mm (range 0 to 5). Of them, 112 (83.0%) cases had margins of 3£¿mm or less, and 26 had margins of 0£¿mm (19.3%). The mean width of margin for 1£¿cm-NSS was 11.6£¿mm (median 12, range 10 15). None of the NSS patients had positive surgical margins. The mean follow-up for mm-NSS, 1£¿cm-NSS and RN patients was 69, 82 and 82 months, respectively. Three mm-NSS patients, two 1£¿cm- NSS and four RN patients died of non-cancer related causes. Two mm-NSS patient (1.6%) experienced local recurrence. No distant metastasis was detected in all the patients. The over all 5-year survivals for NSS and RN patients were 100%, 100% and 98.7%, respectively ( ). Conclusions. Mini-margin NSS is as safe and effective as 1£¿cm-NSS and RN in treating early localized RCC 4£¿cm or less. 1. Introduction Nephron sparing surgery (NSS) has proven to be a safe and effective approach for renal cell carcinoma (RCC), with comparable clinical results to radical nephrectomy, especially for the tumors 4£¿cm or less, even in patients with completely normal opposite kidneys. For many years, surgical practice for NSS was to have a more than 1£¿cm margin of normal tissue around the tumor [1, 2]. However, more recent studies show that the width of the margin seems not important. NSS with a smaller margin is as well safe and effective in tumor control [3]. And even pure enucleation is as effective as partial nephrectomy with a rim of healthy parenchyma [4]. From January 1998 to December 2008, based on the previous studies in our institute, 135 cases of RCC 4£¿cm or less in diameter and staged as T1aN0M0 with normal contralateral kidney were treated with 5£¿mm mini-margin NSS (mm-NSS). The clinical results were followed and compared with 99 cases of NSS with margin 1£¿cm or more (1£¿cm-NSS) and 156 cases of radical nephrectomy (RN) for RCC of same stage. The Data were comparatively analyzed to evaluate the safety and efficacy of mini-margin NSS in treating early localized RCC 4£¿cm or less. 2. Materials And Methods 2.1. Patient Selection Only patients with RCC 4£¿cm or less, with normal contralateral kidney, without lymph node or distant
%U http://www.hindawi.com/journals/au/2010/145942/