| ObjectiveTo compare and analyze the efficacy and prognostic factors of retroperitoneal laparoscopy and open surgery in radical treatment of T2-T3 renal tumors,in order to provide reference for clinical treatment of T2-T3 renal tumors.MethodsA retrospective study was conducted in Yanbian Hospital Affiliated from January 2011 to the stage of laparoscopic radical treatment of renal tumors to September 2020.After strict criteria,80 patients with T2-T3 renal tumors with a diameter greater were screened for surgical-related data,and the clinical efficacy of laparoscopic and open surgery in the treatment of T2-T3 renal tumors after the same period was compared.There were 58 cases of laparoscopic radical nephrectomy(Retroperitoneal laparoscopic radical nephrectomy,RLRN),18 cases of open radical nephrectomy(Open radical nephrectomy,ORN),and 4 cases of laparoscopic reformation after surgery.The general clinical data,operation time,intraoperative blood loss,postoperative drainage tube indwelling time,postoperative hospital stay,postoperative complications and postoperative distant metastasis were compared between RLRN and ORN.Taking the operation time of the patients as the starting time of the study,and taking December 1,2021 as the follow-up deadline,the median follow-up time was 54.5 months,and 60 people were effectively followed up.Univariate and multivariate analyses were performed on survival and prognostic factors.Results1.There were no significant differences in gender,age,hypertension and diabetes,body mass index,tumor location and side,clinical symptoms,pathological types,and postoperative drainage tube indwelling time between the two groups(P>0.05).2.The average operation time of RLRN group and ORN group(157.38±38.99min VS 118.06±34.09min),intraoperative blood loss[80(50～300)ml VS 200(140～400)ml],postoperative hospital stay(7.4±2.18 days VS 8.78±2.53 days)were significantly different between the LRN group and the ORN group(P<0.05).3.There were 6 cases of postoperative complications,including 5 cases in the LRN group,including 1 case of lymphatic leakage(1.7%),1 case of incision infection(1.7%),1 case of intestinal obstruction(1.7%),and 2 cases of pulmonary infection.(3.4%),1 case of intestinal obstruction in ORN group(1.7%),7 cases of postoperative distant metastasis in LRN group,2 cases of bone metastasis(3.4%),2 cases of lung(3.4%),3 cases of brain(6.5%)).There was 1 case(1.7%)of bone at distant metastases in the ORN group.There was no significant difference in postoperative complications and postoperative distant metastases between the LRN group and the ORN group(P>0.05).4.Univariate analysis to compare patients’ age,gender,surgical method,BMI,hypertension,diabetes,clinical symptoms,clinical stage,T stage,tumor size,tumor side,pathological Furhman grade,pathological necrosis under microscope,pathological type 14 items The relationship with prognosis showed that:surgical method,postoperative pathological T staging,Furhman grade,and pathological necrosis were all related to the prognosis of patients,and the difference was statistically significant(P<0.05).5.The results of multivariate analysis showed that the risk regression analysis showed that tumor necrosis under microscope was a significant independent risk factor affecting the prognosis of patients with renal cancer(P<0.05).Conclusion:1.Compared with ORN in the treatment of T2-T3 stage renal tumors,RLRN has advantages in terms of prolonged operation time,intraoperative bleeding,and postoperative hospital stay.There is no significant difference in postoperative complications and postoperative distant metastasis.The treatment of T2-T3 renal tumors is safe and feasible.2.There is no difference in the prognosis of T2-T3 stage renal tumors by surgical methods.For patients with tumor necrosis under microscope,a predictive model of RCC tumor necrosis can be established based on CT and other imaging studies before surgery,and accurate evaluation can be carried out with in vivo chemotherapy and active monitoring after surgery.to improve survival. |
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