Abstract:
OBJECTIVE:To report the long-term follow-up of a matched comparison of radical nephrectomy (RN) and nephron-sparing surgery (NSS) in patients with single unilateral renal cell carcinoma (RCC) and a normal contralateral kidney. PATIENTS AND METHODS:Between August 1966 and March 1999, 1492 and 189 patients with unilateral RCC and a normal contralateral kidney underwent RN and NSS, respectively. Patients with renal impairment, previous nephrectomy, bilateral or multiple RCCs, metastasis, and familial cancer syndromes were excluded. A total 164 patients in each cohort were matched according to pathological grade, pathological T stage, size of tumor, age, sex, and year of surgery. The Kaplan-Meier method and stratified Cox proportional hazards model were used to estimate and compare overall, cancer-specific, local recurrence-free, and metastasis-free survival and survival free of chronic renal insufficiency. The 2 groups were evaluated for early (< or = 30 days) complications and proteinuria at last follow-up. RESULTS:At last follow-up, 126 RN patients (77%) and 130 NSS patients (79%) were alive with no evidence of disease. There was no significant difference observed between patients who had RN and those who had NSS with respect to overall survival (risk ratio, 0.96; 95% confidence interval [CI], 0.52-1.74; P = .88) or cancer-specific survival (risk ratio, 1.33; 95% CI, 0.30-5.95; P = .71). At 10 years, similar rates of contralateral recurrence (0.9% for RN vs 1% for NSS) and metastasis (4.9% for RN vs 4.3% for NSS) were seen in each group, whereas the rate of ipsilateral local recurrence for patients who underwent RN and NSS was 0.8% and 5.4%, respectively (P = .18). There was no significant difference in the early complications between the RN and NSS groups. However, patients who underwent RN had a significantly higher risk for proteinuria as defined by a protein/osmolality ratio of 0.12 or higher (55.2% vs 34.5%; P = .01). At 10 years, the cumulative incidence of chronic renal insufficiency (creatinine > 2.0 mg/dL at least 30 days after surgery) was 22.4% and 11.6%, respectively, for the RN and NSS groups (risk ratio, 3.7; 95% CI, 1.2-11.2; P = .01). CONCLUSIONS:This retrospective study of patients with unilateral RCC and a normal contralateral kidney suggests that NSS is as effective as RN for the treatment of RCC on long-term follow-up. The increased risk of chronic renal insufficiency and proteinuria after RN supports use of NSS.
journal_name
Mayo Clin Procjournal_title
Mayo Clinic proceedingsauthors
Lau WK,Blute ML,Weaver AL,Torres VE,Zincke Hdoi
10.4065/75.12.1236keywords:
subject
Has Abstractpub_date
2000-12-01 00:00:00pages
1236-42issue
12eissn
0025-6196issn
1942-5546pii
S0025-6196(11)63022-Xjournal_volume
75pub_type
杂志文章abstract:OBJECTIVE:To determine the separate effects of exercise intensity and amount on interindividual cardiorespiratory fitness (CRF) response. PARTICIPANTS AND METHODS:Participants were 121 (75 females, 62%) sedentary, middle-aged (mean [SD] age, 53.2 [7.5] years), abdominally obese adults who completed at least 90% of 5 w...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.mayocp.2015.07.024
更新日期:2015-11-01 00:00:00
abstract::Patient-centered care requires that treatments respond to the problematic situation of each patient in a manner that makes intellectual, emotional, and practical sense, an achievement that requires shared decision making (SDM). To implement SDM in practice, tools-sometimes called conversation aids or decision aids-are...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/j.mayocp.2018.08.030
更新日期:2019-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the safety, diagnostic yield, and therapeutic implications of flexible bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy in patients with febrile neutropenia and pulmonary infiltrates. PATIENTS AND METHODS:We retrospectively reviewed the medical records of all patients with...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/80.11.1414
更新日期:2005-11-01 00:00:00
abstract:OBJECTIVE:To record long-term follow-up data on patients with chronic idiopathic meningitis. DESIGN:We retrospectively reviewed the outcome of 49 patients who were examined at the Mayo Clinic between 1978 and 1990. MATERIAL AND METHODS:For all patients, symptoms, signs, laboratory values, results of imaging studies, ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)62246-0
更新日期:1994-06-01 00:00:00
abstract:OBJECTIVE:To investigate the incidence of bone disorders after solid organ transplantation (SOT). PARTICIPANTS AND METHODS:We used Taiwan's National Health Insurance Research Database to identify 9428 recipients of SOT and 38,140 sex- and age- matched control subjects between January 1, 1997, and December 31, 2010, to...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2014.02.017
更新日期:2014-07-01 00:00:00
abstract::Treatment responses to imatinib vary among patients with chronic myeloid leukemia (CML), and definitions of treatment failure and suboptimal response have been published. This article discusses monitoring and treatment of patients with CML after failure of or suboptimal response to imatinib therapy. We reviewed articl...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/S0025-6196(11)60824-0
更新日期:2009-02-01 00:00:00
abstract::Autonomic failure and proximal skeletal myopathy are rare features of the Sjögren syndrome (SS). We describe a 51-year-old woman with primary SS who had development of esophageal dysmotility, urinary retention, severe orthostatism, and skeletal myopathy during a 3-month period after the diagnosis of SS. Her symptoms a...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/74.7.695
更新日期:1999-07-01 00:00:00
abstract::Physical inactivity increases the risk of many chronic disorders. Numerous studies have convincingly demonstrated that undertaking and maintaining moderate levels of physical activity (eg, brisk walking 3 hours a week) greatly reduces the incidence of developing many chronic health conditions, most notably type 2 diab...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.4065/77.2.165
更新日期:2002-02-01 00:00:00
abstract::Glucocorticoids are potent anti-inflammatory agents that play an important role in the therapy of many patients with connective tissue diseases, including systemic lupus erythematosus, polymyalgia rheumatica, various types of vasculitis, and complications of rheumatoid arthritis. Glucocorticoids reduce the number and ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:
更新日期:1980-12-01 00:00:00
abstract::Four patients with infective endocarditis caused by Actinobacillus actinomycetemcomitans are reported. The clinical course was characterized by chronicity. Three of the four patients were treated with combined penicillin and aminoglycoside therapy on an empiric basis; the fourth patient was given ampicillin alone for ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1980-07-01 00:00:00
abstract::Currently, computer-assisted imaging can visualize very fast or very slow nonvisible motion events. We can create measurable geometric representations of physiology, including transformation, blood flow velocity, perfusion, pressure, contractility, image features, electricity, metabolism, and a vast number of other co...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.4065/74.4.399
更新日期:1999-04-01 00:00:00
abstract:OBJECTIVE:To ascertain whether "harmonic imaging"--use of ultrasound signals with the frequency twice that of the transmitted signal for ultrasound image generation--can improve image contrast while reducing noise. METHODS:Technically difficult echocardiograms (nonvisualization of 2 or more endocardial segments in a 1...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/73.11.1066
更新日期:1998-11-01 00:00:00
abstract::Vitamin K antagonists were the only class of oral anticoagulants available to clinicians for decades. However, with the US Food and Drug Administration approval of new oral anticoagulants, such as dabigatran, rivaroxaban, and apixaban, clinicians now have a broader choice. Given the recent approval and availability of...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/j.mayocp.2013.03.006
更新日期:2013-05-01 00:00:00
abstract::Duodenal duplication cysts are rare malformations that characteristically manifest with intestinal obstruction. In a 50-year experience, we found a duodenal duplication cyst in only three patients, one of whom had massive gastrointestinal bleeding as the initial symptom. Six other duplication cysts (two esophageal, on...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)60419-4
更新日期:1985-11-01 00:00:00
abstract::A case of inguinal hernia with massive scrotal enlargement is presented. Walking and voiding had become extremely difficult for the patient; only one testicle could be palpated, and the penis could not be delivered from the scrotal mass. Surgical reduction of the massive hernia was accomplished. The right testis with ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1982-06-01 00:00:00
abstract::There are a number of changes underway in modern clinical bacteriology laboratories. Panel-based molecular diagnostics are now available for numerous applications, including, but not limited to, detection of bacteria and select antibacterial resistance markers in positive blood culture bottles, detection of acute gast...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/j.mayocp.2016.06.020
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVE:To assess whether patients with pancreatic cancer-associated pain living near a pain control center were more likely to undergo neurolytic celiac plexus block (NCPB) than those living at a distance and to determine the rationale of physicians at our institution for referring patients for NCPB. DESIGN:We retr...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/72.9.831
更新日期:1997-09-01 00:00:00
abstract::The first generation of multicenter randomized controlled trials of coronary artery bypass surgery vs medical treatment in the 1970s found survival advantage only in patients with left main coronary artery disease or with multiple risk factors. Over time, these results have remained reproducible and biologically plaus...
journal_title:Mayo Clinic proceedings
pub_type:
doi:10.4065/77.1.72
更新日期:2002-01-01 00:00:00
abstract::A 70-year-old woman was admitted to the hospital with chest discomfort after quarreling with her neighbors. Electrocardiography revealed ST-segment elevation in leads I, II, III, aVL, aVF, and V2 through V6. Coronary angiography demonstrated normal arteries, but left ventriculography showed apical akinesis and basal h...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/79.6.821
更新日期:2004-06-01 00:00:00
abstract:OBJECTIVE:To determine the effect of epinephrine on the QT interval in patients with genotyped long QT syndrome (LQTS). PATIENTS AND METHODS:Between May 1999 and April 2001, 37 patients (24 females) with genotyped LQTS (19 LQT1, 15 LQT2, 3 LQT3, mean age, 27 years; range, 10-53 years) from 21 different kindreds and 27...
journal_title:Mayo Clinic proceedings
pub_type: 临床试验,杂志文章
doi:10.4065/77.5.413
更新日期:2002-05-01 00:00:00
abstract::A prospective, stratified, randomized 3-year clinical trial was conducted on the effect of rigorous versus conventional glucose control on peripheral nerve function in 33 insulin-treated diabetic patients with a duration of diabetes of less than 2 years. The goals for conventional glucose control were the mean of fast...
journal_title:Mayo Clinic proceedings
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1983-05-01 00:00:00
abstract::Restless legs syndrome (RLS)/Willis-Ekbom disease (WED) is a common disorder, occurring at least twice a week and causing at least moderate distress in 1.5% to 2.7% of the population. It is important for primary care physicians to be familiar with this disorder and its management. Much has changed in its management si...
journal_title:Mayo Clinic proceedings
pub_type: 共识发展会议,杂志文章
doi:10.1016/j.mayocp.2013.06.016
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVE:To determine whether a diet of high saturated fat and avoidance of starch (HSF-SA) results in weight loss without adverse effects on serum lipids in obese nondiabetic patients. PATIENTS AND METHODS:Twenty-three patients with atherosclerotic cardiovascular disease participated in a prospective 6-week trial at...
journal_title:Mayo Clinic proceedings
pub_type: 临床试验,杂志文章
doi:10.4065/78.11.1331
更新日期:2003-11-01 00:00:00
abstract:OBJECTIVE:To review the association of coronary artery calcification with coronary atherosclerosis and its potential clinical application as detected on electron beam computed tomography (EBCT). DESIGN:A literature review of coronary artery calcification, coronary artery disease, and EBCT is presented, and clinical ap...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.4065/71.4.369
更新日期:1996-04-01 00:00:00
abstract:OBJECTIVE:To compare the efficacy and tolerability of extended-release oxybutynin chloride and tolterodine tartrate at 12 weeks in participants with overactive bladder. SUBJECTS AND METHODS:The OBJECT (Overactive Bladder: Judging Effective Control and Treatment) study was a prospective, randomized, double-blind, paral...
journal_title:Mayo Clinic proceedings
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:2001-04-01 00:00:00
abstract::Sleep disorders and neurodegenerative diseases are commonly encountered in primary care. A common, but underdiagnosed sleep disorder, rapid eye movement sleep behavior disorder (RBD), is highly associated with Parkinson disease and related disorders. Rapid eye movement sleep behavior disorder is common. It is estimate...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/j.mayocp.2016.07.019
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVE:To identify medical practices that offer no net benefits. METHODS:We reviewed all original articles published in 10 years (2001-2010) in one high-impact journal. Articles were classified on the basis of whether they addressed a medical practice, whether they tested a new or existing therapy, and whether resu...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/j.mayocp.2013.05.012
更新日期:2013-08-01 00:00:00
abstract::In this article, we describe an integrated approach for detection and evaluation of solitary pulmonary nodules. Initial evaluation of the solitary pulmonary nodule includes tomography, fluoroscopy, and comparison with previously obtained roentgenograms. Subsequently, thin-section computed tomography and phantom densit...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/s0025-6196(12)65012-5
更新日期:1990-02-01 00:00:00
abstract:OBJECTIVE:To determine relationships among pregnancy (during and postpartum), acute pancreatitis, and gallstones. PATIENTS AND METHODS:In this retrospective population-based case-control study, we identified all 12- to 50-year-old Rochester, Minn, females diagnosed between 1976 and 1991 as having acute pancreatitis (c...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/75.4.361
更新日期:2000-04-01 00:00:00
abstract::In a study of 49 consecutive patients for whom a test for platelet antibodies had been ordered, tests were performed for both cell-bound and serum platelet antibodies. In cases of autoimmune thrombocytopenia (ITP), the test result for cell-bound antibody was more likely to be positive than was the test result for seru...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)65623-7
更新日期:1984-12-01 00:00:00