Open partial nephrectomy for entirely intraparenchymal tumors: a matched case-control study of oncologic outcome and complication rate

Abstract

Purpose To compare the oncologic and clinical outcomes for open partial nephrectomy (OPN) performed in patients with entirely intraparenchymal tumors versus case-matched controls, with exophytic lesions.Material and methods Patients having undergone OPN between 2007 and 2012 were investigated. Exclusion criteria included patients with a benign tumor, advanced malignancy, malignancies other than renal cell carcinoma, end-stage renal failure, or 3 or more co-existing chronic diseases. Individuals with tumors that were invisible at the renal surface were identified, and then matched with 2 controls chosen for tumor size, pathology, age, follow-up period, and presence of a solitary kidney. Oncological status, perioperative, and postoperative data were collected and compared between groups.Results 17 individuals with entirely endophytic RCC tumors and available oncologic status were identified. For five patients, only one suitable control could be identified, bringing the control group number to 29. All tumors were clear cell carcinomas staged at pT1a. Median tumor size was 25mm for endophytic lesions, and 27mm for exophytic masses (P=0.32). The operative period was extended by 20 minutes for intrarenal tumors (P=0.03), with one case of a positive surgical margin in each group (P=0.7). There were no significant differences in perioperative or postoperative complications. Median follow-up was 47 and 43 months for patients with endophytic and exophytic tumors respectively. Disease recurrence was recorded in one patient after endophytic tumor resection, and in four controls (P=0.4).Conclusions OPN shows equivalent safety and efficacy for both intrarenal RCC tumors and exophytic tumors of the same size and type.

Are there limits of robotic partial nephrectomy? TRIFECTA outcomes of open and robotic partial nephrectomy for completely endophytic renal tumors

“…24 Most interestingly, many studies report lower complication rates for RAPN. 15,18,23 These differences seem to diminish when it comes to endophytic tumors as the current and previous data suggest. 8 Beside low complications, renal function during PN is crucial especially in endophytic tumors were prolonged ischemia times have been reported.…”

“…Remarkably, positive surgical margins were not observed in any RAPN case and in two OPN cases only (2.6%). Hence, the current PSM rates are below the reported range of 3‐12% for endophytic tumors across both approaches and strengthen the evidence that both techniques may offer an oncologically save resection even in highly challenging tumors . The complication rates in this study are relatively high compared to previous studies most likely reflecting the unique patient selection .…”

“…The complication rates in this study are relatively high compared to previous studies most likely reflecting the unique patient selection . Most interestingly, many studies report lower complication rates for RAPN . These differences seem to diminish when it comes to endophytic tumors as the current and previous data suggest …”

“…Hence, the current PSM rates are below the reported range of 3-12% for endophytic tumors across both approaches and strengthen the evidence that both techniques may offer an oncologically save resection even in highly challenging tumors. 8,18,[21][22][23] The complication rates in this study are relatively high compared to previous studies most likely reflecting the unique patient selection. 24 Most interestingly, many studies report lower complication rates for RAPN.…”

Surgical treatment for renal masses in the elderly: analysis of oncological, surgical and functional outcomes

“…These changes arise from the fact that PN reduces the risk of postoperative renal insufficiency and is associated with longer overall survival with oncologic outcome similar to RN in T1 tumors (8, 9). Along with surgical technique advances, even most-complex tumors like entirely endophytic masses (10) and tumors larger than 4 cm can be treated with nephron-sparing approach (8, 11). Due to aforementioned reasons, partial nephrectomy is currently recommended whenever feasible (12, 13).…”