Efficacy of Nephron-Sparing Surgery for Renal Cell Carcinoma: Analysis Based on the New 1997 Tumor-Node-Metastasis Staging System

Belldegrun, Arie S.; Tsui, Ke‐Hung; deKernion, Jean B.; Smith, Robert B.

doi:10.1200/jco.1999.17.9.2868

Cited by 275 publications

(116 citation statements)

References 11 publications

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“…However, after multiple retrospective series demonstrated oncologic equipoise, partial nephrectomy (PN) became an option, allowing for the preservation of normal renal parenchyma. [1][2][3] Whereas adverse health-related quality of life outcomes associated with procedures such as radical mastectomy are immediately visible, those associated with renal cell carcinoma (RCC) treatment are more subtle due to the long-term consequences of nephron loss. Although it has long been recognized that rendering a patient anephric has life-altering consequences, RN was not believed to pose significant health consequences in the presence of a normal contralateral kidney.…”

Section: Introductionmentioning

confidence: 99%

Overall survival advantage with partial nephrectomy: A bias of observational data?

Shuch¹,

Hanley

Lai

et al. 2013

Cancer

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the Urologic Diseases in America ProjectBACKGROUND: Partial nephrectomy (PN) and radical nephrectomy (RN) are standard treatments for a small renal mass. Retrospective studies suggest an overall survival (OS) advantage, however a randomized phase 3 trial suggests otherwise. The effects of both surgical modalities on OS were evaluated compared with controls. METHODS: A matched cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset. Individuals treated with PN or RN for localized renal cell carcinoma (RCC) measuring 4 cm were compared with 2 control groups (non-muscle-invasive bladder cancer (BCC) and noncancer controls (NCC). Using a greedy algorithm, RCC groups were matched with controls by demographics and comorbidities. OS for surgical groups and controls were compared. The cause of death was evaluated for cancer groups when differences in OS were noted. RESULTS: Patients undergoing PN and RN were matched with controls. All cancer groups had >95% 10-year cancer-specific survival (CSS). Median OS was similar between RN (9.05 years) and BCC (8.67 years; P 5.067) and NCC (8.77 years; P 5.49). Median OS was improved for PN (10.45 years) compared with BCC (8.75 years; P<.001) and NCC controls (8.76 years; P<.001). A multivariate Cox hazards model demonstrated that PN improved OS compared with NCC (hazard ratio, 1.257; P<.001) and BCC (hazard ratio, 1.364; P<.001). CONCLUSIONS: RN patients had similar OS compared with controls, suggesting that this treatment modality does not compromise survival. Patients undergoing PN had improved OS compared with controls, suggesting possible selection bias. The apparent survival advantage conferred by PN in SEER-Medicare case series is likely the result of selection bias involving unmeasured confounders.

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Section: Introductionmentioning

confidence: 99%

Overall survival advantage with partial nephrectomy: A bias of observational data?

Shuch¹,

Hanley

Lai

et al. 2013

Cancer

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“…Nephron-sparing surgery has its share of complications including urinary leak (1.4-17.4 %), acute or delayed hemorrhage (1.3-7.9 %), acute renal failure (1.3-12.7 %), and chronic renal insufficiency [16]. However, these complications have declined in the last decade owing to better patient selection, operating techniques, perioperative care, and surgical experience.…”

Section: Discussionmentioning

confidence: 99%

Management of Bilateral Wilms’ Tumor: Our Experience

Raghunath

Jadhav

Shankar

et al. 2016

Indian J Surg Oncol

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Management of bilateral Wilms' tumor is particularly challenging, considering the chances of recurrence and long-term renal function for affected patients. Aggressive surgical resection to prevent recurrence must be balanced with the desire to preserve renal function. We evaluated our experience in the management of bilateral Wilms' tumor stressing the challenges encountered in decision making and the role of nephron sparing surgery. We had four children presenting with bilateral Wilms' tumor. All of them were appropriately staged and given standard chemotherapy as per NWTS-5 guidelines. Tumors were considered to have a 'good' response to chemotherapy if sufficient tumor shrinkage was observed so that renal hilum was seen free of tumor and vice versa. Nephron-sparing surgery was considered in all and was performed when feasible, followed by completion adjuvant chemotherapy. All patients were followed up with serial ultrasound scans (3-6 monthly) and CECT abdomen (yearly once). Blood urea and serum creatinine, hypertension, and proteinuria were assessed during follow-up visits. All four children received neo-adjuvant chemotherapy as per NWTS-5 guidelines. The first child had poor response to chemotherapy and was considered for left radical and right partial nephrectomy. However, patient attenders refused any surgical intervention and the child was taken home. The second child had a 'good' response on left side and was planned for left partial and right radical nephroureterectomy based on pre-operative imaging analysis. However, intra-operatively, bilateral partial nephrectomy with good margins was feasible. The third child though, showed 'poor' response to pre-op chemotherapy and warranted bilateral nephroureterectomy, right partial and left radical nephroureterectomy was feasible. However, in the fourth child, we were not able to perform nephron sparing surgery and left nephroureterectomy with right tumor biopsy was done. Following this, child was started on 2nd-line chemotherapy, now awaiting right partial nephrectomy. The second child is on follow up for 1.5 years, doing well. However, the third child expired 1.5 years following surgery due to recurrence (lung metastasis). Management of bilateral Wilm's tumor is challenging and nephron-sparing surgery should be considered in all patients having bilateral Wilm's tumor with favorable histology, even if pre-operative imaging studies suggest that the lesions are unresectable.

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“…A incidência de tumores com menos de 4 cm aumentou de 28%, em 1985, para 61% em 1995 12 e o tamanho médio dos tumores reduziu de 7,8 cm, em 1989, para 5,3 cm em 1998 15 . Quanto à evolução, tumores menores de 4cm têm excelente prognóstico quando tratados com nefrectomia radical ou cirurgia conservadora 8,10,15 , contudo resultados semelhantes foram obtidos para tumores inferiores a 7 cm, porém a maioria desta casuística era composta por tumores com menos de 4 cm 16 . Devido ao tamanho tumoral como um fator prognóstico de doença localizada ainda ser controverso, julgamos a cirurgia conservadora , justificando a subdivisão em T1 para a melhor seleção de candidatos à cirurgia renal conservadora 7 .…”

Section: Discussionunclassified

“…O atual TNM 97 comporta maior núme-ro de casos PT1 com forte correlação com a sobrevida, pelo fato da doença órgão confinada oferecer evolução satisfatória, com boa distinção prognóstica nos diferentes estádios da doença 16,28 . Como a sobrevida em cinco anos para o atual PT1 varia entre 85% 29 a 91% 26 , uma das razões de se propor a mudança no TNM seriam as diferenças prognósticas em um mesmo estádio como é evidenciada por Hafez et al 8 cuja sobrevida câncer específica para cinco anos foi de 98%, 88% e 82% para tumores até 4 cm, 4-7 cm REESTADIAMENTO DO CÂNCER RENAL e > 7 cm, respectivamente.…”

Section: Discussionunclassified

O estadiamento TNM do carcinoma de células renais deve ser modificado novamente ?

Dall’Oglio¹,

Srougi²,

Nesrallah³

et al. 2003

Rev. Assoc. Med. Bras.

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RESUMO -OBJETIVOS. O comportamento do carcinoma de células, porém já existem propostas para modificá-lo novamente 7,8,9 . Estudos atuais relatam excelentes resultados com cirurgia conservadora 10 , no entanto a maioria não compara a sobrevida entre os pacientes com tamanhos tumorais distintos.Nós, retrospectivamente, avaliamos o tamanho tumoral e a presença de fatores prognósticos na recorrência e sobrevida dos pacientes com CCR com objetivo de rediscutir o ponto de corte do atual T1(TNM-1997), julgando que existe uma diferença substancial no prognóstico dos tumores a partir de 4 cm de diâmetro. MÉTODOSNo período entre janeiro de 1988 e julho de 1999, 128 pacientes com CCR foram operados por um mesmo grupo de cirurgiões nos Hospitais Sírio Libanês e Beneficência Portuguesa de São Paulo sendo avaliados retrospectivamente. A avaliação pré-operatória compreendeu exames hematológicos e exames de imagem como a ultra-sonografia (US), tomografia computadorizada (TC) e/ou ressonância nuclear magnética, urografia excretora, cinti- lografia óssea e radiografia de tórax. O seguimento pós-operatório variou entre 2 e 138 meses (mediano: 33 meses). Os pacientes foram consultados sobre a participação no estudo através de carta informativa e termo de consentimento pós-informação e posteriormente foi feita análise retrospectiva através dos dados de prontuário. Destes, foram excluídos oito pacientes porque tinham material anatomopatológico insuficiente para revisão ou este era inconclusivo.As informações clínicas resgatadas destes prontuários incluíram idade, sexo, rim acometido, data do diagnóstico, apresentação clínica inicial, propedêutica, histórias pregressas, antecedentes pessoais e familiares, terapia cirúrgica realizada (radical ou conservadora), laudo anatomopatológico e seguimento pós-operatório.Todo material anatomopatológico (lâ-minas coradas com H.E e fragmentos blocados em parafina) foi revisado ao microscópio ótico por um único patologista. O acompanhamento pós-operatório foi realizado no consultório e quando a última consulta se deu há mais de três meses houve

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Efficacy of Nephron-Sparing Surgery for Renal Cell Carcinoma: Analysis Based on the New 1997 Tumor-Node-Metastasis Staging System

Cited by 275 publications

References 11 publications

Overall survival advantage with partial nephrectomy: A bias of observational data?

Overall survival advantage with partial nephrectomy: A bias of observational data?

Management of Bilateral Wilms’ Tumor: Our Experience

O estadiamento TNM do carcinoma de células renais deve ser modificado novamente ?

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