33例肾癌根治术后局部复发患者的手术治疗

Surgical management for local retroperitoneal recurrence of 33 renal cell carcinoma patients underwent radical nephrectomy

目的探讨肾癌根治术后局部复发患者手术治疗的疗效。方法回顾性分析2010年1月至2018年4月在上海交通大学医学院附属仁济医院行肾癌根治术后局部复发病灶切除术的33例患者的临床和随访资料。结果33例患者中,男25例,女8例;中位年龄54岁。行根治性肾切除术时的病理分期为pT1~2N0M0期14例,pT3~4N0M0期16例,pN1期3例。仅有4例患者复发时出现症状,其他均为根治术后随访影像学检查发现。33例患者的中位复发时间为30个月,中位复发肿瘤直径4.5 cm。所有患者均行开放手术,其中29例患者完整切除局部复发病灶,4例患者无法完整切除复发病灶转为姑息手术。中位术中出血500 ml,术后中位住院时间为4 d。术后5例患者出现ClavienⅠ~Ⅱ级并发症,无Ⅲ~Ⅴ级严重并发症发生。6例患者术后使用靶向药物治疗,其中1例患者术后出现远处转移。未行辅助治疗的27例患者中,有12例患者术后出现远处转移。33例局部复发患者术后中位生存时间为31个月,1年和3年生存率分别为86.8%和36.9%。结论肾癌根治术后严密影像学复查可以尽可能地在局部复发患者中尽早发现局部复发病灶,并对局部复发的手术切除完整性有预测作用。肾癌根治术后局部复发的手术虽然出血相对较多,但手术安全,术后并发症可控。术后靶向治疗可能使局部复发患者生存获益。

Objective To investigate the therapeutic effects of surgical management for local retroperitoneal recurrence of renal cell carcinoma after radical nephrectomy. Methods Clinical and follow-up data of 33 cases of local recurrence after radical nephrectomy in Renji Hospital from January 2010 to April 2018 were retrospectively analyzed. Results In these 33 patients, 25 was male and 8 was female;The median age was 54 years old. The pathological stage of radical nephrectomy included 14 cases of pT1-2N0M0 stage, 16 cases of pT3-4 N0M0 stage, and 3 cases of pN1 stage. Only 4 relapsing patients had symptoms, the others were all found to have recurrence by imaging examination during follow up period of postoperation.The median recurrence time for all patients was 30 months, and the median diameter of recurrent tumors was 4.5 cm.Twenty-nine patients underwent complete resection of local recurrent lesions, and 4 patients whose recurrent lesions could not be completely resected converted receive palliative surgery. The median intraoperative blood loss was 500 ml and the median hospital stay after surgery was 4 days. Clavien grade Ⅰ-Ⅱ complications occurred in 5 patients after surgery, and no serious complications of Clavien grade Ⅲ-Ⅴ complications occurred. Six patients received postoperative adjuvant target therapy and distant metastasis occurred in one patient.In the 27 patients without adjuvant target therapy, postoperative distant metastases occurred in 12 patients. The median survival time for all patients after local recurrence surgery was 31 months. The 1-year and 3-year survival rates were 86.8% and 36.9%, respectively. Conclusions The rigorous imaging examination after radical nephrectomy can detect local recurrent lesions as early as possible in most relapsing patients and imaging examination can predict the integrity of surgical resection of local recurrence.Although intraoperative bleeding of resection of local recurrence is relatively high, the operation is safe and the postoperative complications are controllable. Postoperative adjuvant therapy may also provide better survival benefit for patients with local recurrence.