Contemporary Experience with Partial Nephrectomy for Stage T2 or Greater Renal Tumors

Abstract

The purpose of this paper is to review current studies on the topic of partial nephrectomy (PN) for renal masses stage T2 and greater. We conducted a PubMed literature review of English language articles published from 2000 onward. Eight studies were selected for this review including 359 PN patients. Median tumor size was 7.5 to 8.7, and tumor histology was mainly clear cell. Technique was mainly open, the reported median ischemia time was 29-45 min, and median operative time 170-221 min. Positive margin rates were 0-31%. On a median follow-up range of 13.1 to 70 months, 5-year progression-free survival was 71-92.5%, and 5-year overall survival was 66-94.5% in the study populations. There is limited retrospective evidence in favor of preserved oncologic efficacy in patients with renal tumors larger than 7 cm in size treated with nephron-sparing surgery. This review emphasizes the need for more studies and long-term follow-up data to determine the proper role of partial nephrectomy in large kidney tumors.

Comparison by Pentafecta Criteria of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Large Renal Tumors

“…Retrospective studies reported patients with cT2a tumors demonstrated less differences in eGFR at 12 months than patients with with cT1 tumors after open, LPN and RPN. 13,29 Before our study, however, no studies have compared reduction in eGFR after one postoperative year between TRPN and RRPN in patients with ‡4 cm renal tumors. In our study, change in eGFR at 1 year postoperation was significantly more decreased at 1 year after RRPN than after TRPN for all patients ( p = 0.006) and patients with ‡4 cm renal tumors ( p = 0.008).In patients with ‡4 cm renal tumors, mean decrease in eGFR at 1 year postoperation was more than 10% for RRPN.…”

Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: Results of a multicenter cohort with long-term follow-up

“…But overall, we demonstrated a significant OS benefit after NSS ( Fig 1 ). Very few studies addressed elective NSS for pT2 or higher rated renal tumors [ 12 , 14 , 24 – 28 ]. Jelders et al included only 29 NSS patients, as Breau et al included only very few patients undergoing elective NSS in their cohorts, both groups did not provide any information about the imperative indication of NSS [ 25 , 26 ].…”

Robot‐assisted partial nephrectomy for large renal masses: a multi‐institutional series

“…A multi‐study review of both open and laparoscopic PNs showed minimal change in chronic renal function compared with baseline . At discharge, renal function was inferior in the T2a group undergoing PN, however this difference equilibrated at 12‐month follow‐up.…”

“…This has led to PN being increasingly performed for larger tumours . A few studies have shown that open and laparoscopic PN for T2a tumours is safe, with low peri‐operative complication rates ; however, there are only a few case reports on the feasibility of RAPN for T2a tumours . Radical nephrectomy (RN) is still used for many cT1b tumours and is the recommended treatment for T2a (7 to <10 cm) and greater tumours .…”