Comparison Of Efficacy And Safety Of PN And RN In The Treatment Of Stage T1b And T2a Renal Cell Carcinoma

Objective :To evaluate the efficacy,safety,and long-term prognosis of partial nephrectomy(PN)versus radical nephrectomy(RN)for stage T1 b and T2 a renal cell carcinoma.Methods :The clinical data of 115 patients with stage T1 b and T2 a renal cell carcinoma treated with PN and RN in our hospital from April 2014 to July 2017 were selected,including 55 patients treated with PN(PN group:T1b=30,T2a=25)and 60 patients treated with RN(RN group:T1b=30,T2a=30).To compare the preoperative general clinical data,perioperative related factors,proportion of surgical complications and proportion of serious postoperative complications(Clavien classification≥3),renal function recovery outcome(comparison of preoperative and postoperative serum creatinine(Scr))and 5-year survival rate,5-year recurrence-free metastasis rate,and5-year tumor-specific survival rate in the two groups treating stage T1 b and T2 a renal cell carcinoma.A comparative analysis of these clinical data was used to assess the efficacy,safety,and long-term prognosis of PN versus RN in stage T1 b and T2 a renal cell carcinoma.The collected clinical data were analyzed and processed using statistical software,and differences were considered statistically significant at P <0.05.Results :The general clinical data of 115 patients in PN and RN groups were statistically analyzed and compared,with 55 patients in the PN group and 60 patients in the RN group.The results of statistical analysis showed that the preoperative gender,age,BMI,clinical symptoms,tumor diameter,tumor location(left/right),pathological type,Fuhrman nuclear classification,surgical approach,and R.E.N.A.L score were not statistically significant(P > 0.05)in both groups,and the balance of patients in both groups was good.In terms of perioperative period,the PN group did not differ significantly from the RN group in terms of operative time,intraoperative bleeding,drainage tube retention time,postoperative hospital stay,postoperative Hb change values,positive incision margins,and secondary surgery(P>0.05).Regarding the surgical complications in both groups,the total number of cases with surgical complications in the PN group was 13(23.60%)and the total number of cases with surgical complications in the RN group was 5(8.33%),which was significantly higher in the PN group than in the RN group,and the difference was statistically significant(P<0.05)when comparing the two groups P=0.024.In both groups,4cases(7.27%)of serious postoperative complications(Clavien grade≥3)were present in the PN group,with postoperative renal artery embolization,retroperitoneal exploratory hemostasis,and retroperitoneal pyeloplasty,respectively.Two cases(3.33%)were present in the RN group,which were treated with postoperative retroperitoneal exploratory hemostasis and transfer to ICU,respectively,and the difference between the two groups was not significant at P=0.597(P>0.05).In terms of renal function recovery between the two groups,there was no statistically significant difference between the PN group and the RN group in terms of preoperative blood creatinine(P=0.064)(P>0.05),while there was a statistically significant difference between the PN group and the RN group in terms of postoperative blood creatinine values at day 1,3,6 and 12 months(P<0.05).Both groups were followed up for 5 years after surgery and were effectively followed up,with 5 deaths(9.09%)in the PN group and 7 deaths(11.7%)in the RN group,with a non-significant difference between the two groups in terms of 5-year survival rate P=0.652(P>0.05).There were 3cases(5.45%)of recurrent metastases in the PN group and 6 cases(10%)of recurrent metastases in the RN group,and the metastatic locations included lung,liver,perirenal lymph nodes,retroperitoneal lymph nodes,pleura,cervical lymph nodes and bone metastases,and all of them were treated with oral targeted drugs,and the difference in the 5-year recurrence-free metastasis rate between the two groups was not significant at P=0.576(P>0.05).There were 3 tumor-specific deaths(5.45%)in the PN group and 4tumor-specific deaths(6.67%)in the RN group,and the difference was not significant when comparing the two groups in terms of 5-year tumor-specific survival P=1.0(P>0.05).Conclusion :In patients with stage T1 b and T2 a renal cancer,both PN and RN are generally safe and effective when treated,and both achieve good oncologic control.Compared with RN,PN is more effective in protecting postoperative renal function,but is associated with a higher rate of surgical complications,while the difference in serious postoperative complications(Clavien grade ≥3)is not significant,so the decision of whether to perform PN depends on the size and location of the tumor and the clinical experience of the surgeon.