New Practical Staging Of Renal Cell Carcinama

OBJECTIVE:With the development of the diagnosis technology,more and more renal cell carcinama(RCC)are found.In the past decade,several new therapy options for RCC have been devised in an attempt to minimize operative morbidity.and at the same time,Robson staging and TNM staging gradually expose flaws,so According to tumor location,size,and relation between with collection system,kidney capsule, we establish a new stage of RCC,which is divided into 8 stages and 3 types。The clinical date of 86 cases of RCC from 2004 to 2007 were retrospectively.Laparoscopic surgery was performed in all the 85 cases.We will analyse the location of tumor,the size and other other clinical characters before operation and after operation.To measure the properative and postoperative figure of laboratory examination.To evaluate the clinical effects of surgical treatment of RCC with practical effect of the new stage.METHODS:Laparoscopy.surgery was performed in 85 patients with RCC including 3 with solitary kidney,9 with unilateral tumor and contralateral renal compromise.and 73 with unilateral tumor and nomor solitary kidney.1 patient has shown bone metastasis。The diameter of the tumors ranged from 0.8 to 20cm,with a mean of 4.5 cm.70 cases are detected by B ultrasound,72 cases are detected by CT,32 cases are detected by MRI.Of these lesions,Ⅰa,Ⅰb,Ⅰc accounted for 1.16%,1.16%,2.32%,Ⅱa,Ⅱb,Ⅱc accounted for 10.47%,16.28%,12.79%,Ⅲa,Ⅲb,Ⅲc accounted for 6.98%,10.47%,3.49%,Ⅳa,Ⅳb,Ⅳc is 4.65%,4.65%,5.81%, Ⅴa,Ⅴb,Ⅴc is 2.32%,3.49%,4.65%,Ⅵa,Ⅵb,Ⅵc is 2.32%,1.16%,4.65%。17 cases(Ⅳ=2 cases,Ⅴ=8cases,Ⅵ=seven cases)came with hematuria,1 patient with bone metastasis came with Lumbosacral pain,the others were found with no Symptoms。The case with bone metastases was advised to accept comprehensive treatment。The 85 cases performed withL aparoscopy.surgery,with no local or distant metastasis,and noⅣC renal vein thrombosis,all surgical margin pathological examination were no tumor-infiltrating。RESULTS:The case with bone metastases was advised to accept comprehensive treatment,in the rest of 85 cases,60 cases were treated with laparoscopic radical nephrectomy for renal cell carcinoma and 25 with laparoscopic partial nephrectomy. Operation time was as follows,there were 10 cases performed with nephron sparing surgery(NSS)in stageⅡ,Ⅱa,Ⅱb,Ⅱc spend 102min,136min,210min in average, there were 6 cases performed with NSS in stageⅢ,Ⅲa,Ⅲb,Ⅲc spend 132min,153min,246min each,Patients withⅣ,Ⅴ,Ⅵstage were performed with radical nephrectomy,time was 85min,98min,112min respectivly,All patients were followed up for an average of 26 months(7 to 41 months).one patients suffered a left lung ang mediastinum metastasis 35 months after the surgey later and 1with chronic glomerulonephritis required dialysis 28 months after the operation.No surgical complication or local recurrence were found in other patients.CONCLUSIONS.We propose the new practical staging of renal cell carcinoma which stressed the importance of the tumor location,it will make good effect in the surgical treatment of renal cell carcinoma。First Preoperative treatment can be identified,secong the practical stage can be able to assess the prognosis.