Objectives:To assess the outcomes of laparoscopic radical nephrectomy (LRN) in patients with moderate-to-high R.E.N.A.L. score T1b renal cell carcinoma (RCC), with particular attention to the incidence and prognostic implications of sarcomatoid and other aggressive pathological variants. The management of T1b RCC with moderate-to-high R.E.N.A.L. nephrometry scores presents unique challenges in surgical decision-making. Although partial nephrectomy has shown benefits in renal function preservation, the optimal approach for complex tumors remains debatable.Methods:A retrospective analysis was performed on patients who underwent LRN for T1b RCC with moderate-to-high R.E.N.A.L. scores (≥8) between 2008 and 2024. Primary outcomes included perioperative complications, renal function preservation, and pathological findings. All patients return for follow-up one month after surgery with laboratory tests. An upper abdominal and urinary tract ultrasound is performed at three months, and an additional CT or ultrasound examination is recommended during the first postoperative year, then every six months for the first three years, and annually thereafter. Creatinine levels were monitored preoperatively and at multiple time points postoperatively up to 30 months.Results:A total of 118 patients (62 male; 56 female) with a mean age of 66.9 years underwent LRN. The average R.E.N.A.L. score was 10.02, with a mean tumor diameter of 6.0 cm by CT and 4.7 cm by pathology. Mean operative time was 151.6 min, with average blood loss of 75.2 mL. A total of nine complications were reported (7.6%). Pathological analysis revealed aggressive features in 29.7% of cases, including high-grade tumors (G3), multiple tumors, and rare aggressive variants.Conclusions:LRN appears to be a safe and effective treatment option for T1b RCC with moderate-to-high R.E.N.A.L. scores, providing adequate oncological control while maintaining acceptable renal function. The high incidence of aggressive pathological features (29.7%) supports the role of radical nephrectomy in this patient population.
目的：评估腹腔镜根治性肾切除术（LRN）治疗中高R.E.N.A.L.评分T1b期肾细胞癌（RCC）的疗效，特别关注肉瘤样及其他侵袭性病理亚型的发生率及其预后意义。对于具有中高R.E.N.A.L.肾测量评分的T1b期RCC，其治疗策略在外科决策中面临独特挑战。尽管肾部分切除术在保留肾功能方面显示出优势，但对于复杂肿瘤的最佳治疗方式仍存在争议。 方法：对2008年至2024年间因中高R.E.N.A.L.评分（≥8分）T1b期RCC接受LRN治疗的患者进行回顾性分析。主要观察指标包括围手术期并发症、肾功能保留情况及病理学结果。所有患者术后一个月返院复查实验室检查。术后三个月进行上腹部及尿路超声检查，建议在术后第一年内增加一次CT或超声检查，随后三年内每六个月复查一次，之后每年复查一次。监测术前及术后长达30个月内多个时间点的肌酐水平。 结果：共有118例患者（男性62例，女性56例）接受LRN治疗，平均年龄66.9岁。平均R.E.N.A.L.评分为10.02分，CT显示平均肿瘤直径为6.0厘米，病理学测量为4.7厘米。平均手术时间151.6分钟，平均失血量75.2毫升。共报告9例并发症（7.6%）。病理学分析显示29.7%的病例存在侵袭性特征，包括高级别肿瘤（G3级）、多发性肿瘤及罕见侵袭性亚型。 结论：对于具有中高R.E.N.A.L.评分的T1b期RCC，LRN是一种安全有效的治疗选择，能在维持可接受肾功能的同时提供充分的肿瘤控制。高达29.7%的侵袭性病理特征发生率支持根治性肾切除术在该患者群体中的应用价值。
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