The Study Of Clinical Application Of Nephron Sparing Surgery For Renal Cell Carcinoma

Objectives:1.To compare the outcomes of patients who had a nephronsparing surgery(NSS) or radical nephrectomy(RN) for renal cellcarcinoma(RCC) of 4-7cm,including local recurrence, distant recurrence andtumor specific survival.2.To discribe the status of nephron sparing surgery forrenal cell carcinoma in West China Hospital and compare non- ischemicalsurgery with ischemical surgery.Method: 1.According to the Cochrane reviewer's handbook, we design thesearch strategy and define the searching area ,which includes Medline,Embase, Cochrane library, CBM. Relevant literature was found throughcomputer search and marmual search.The quality of research was evaluatedaccording to the principles of evidence-based medicine(EBM). Data wereextracted by two reviewers using the designed forms.The softwareRevman4.2 was used for data analysis.2.A retrospective analysis of 32patients undergoing nephron sparing surgery for renal cell carcinoma of4-7cm was performed using the database of West China Hospital,SichuangUniversity.Data were obtained for each patient including tumor size,type of surgery(non-ischemical surgery or ischemical surgery), ischemical time andso on.Result: 1.Three studies were included in our systematic review and all ofthem were cohort study.The result of meta-analysis demonstrated thatnephron sparing surgery did not increase the risk of local recurrence,distantmetastasis and did not decrease tumor specific survival.The OR and 95%CIwere 2.29(0.92- 5.72),0.24(0.10-0.55),3.71(1.69-8.17) respectively.Thedifference of distant metastasis and tumor specific survival was caused bybias and it did not exist when multi-variant analysis was used.2.Ischemicalsurgery was associated with more crystal infusion and overall fluid infusion.Conclusion:1. Nephron sparing surgery doesn't increase the risk of localrecurrence,distant metastasis and did not decrease tumor specific survival forpatients with renal cell carcinoma of 4-7cm.However,more studies of highquality are required.2. Nephron sparing surgery can be carried outsafely,though there are still some processes to be improved. Ischemicalsurgery was associated with more crystal infusion and overall fluid infusion.