Guideline for Management of the Clinical T1 Renal Mass

Campbell, Steven C.; Novick, Andrew C.; Belldegrun, Arie S.; Blute, Michael L.; Chow, George K.; Derweesh, Ithaar; Faraday, Martha M.; Kaouk, Jihad; Leveillee, Raymond J.; Matin, Surena F.; Russo, Paul; Uzzo, Robert G.

doi:10.1016/j.juro.2009.07.004

Cited by 1,610 publications

(1,020 citation statements)

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“…[2][3][4] Current guidelines from the American, European, and Canadian Urologic Associations all recommend PN as the standard treatment for T1a renal tumours. 43,56,57 In 2008, approximately 45% of patients surgically managed for T1a tumours in the United States underwent PN rather than RN. 58 Results from Canadian population studies have demonstrated parallel patterns of dissemination with a slow but steady uptake of PN over the past decade.…”

Section: The Current Standard -Partial Nephrectomymentioning

confidence: 99%

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886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

European Urology Supplements

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The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). PN has been associated with better long-term renal function, and has also been linked to improved cardiac morbidity and overall survival. However, the relationship between treatment choice and definitive outcomes of chronic kidney disease (CKD) are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy.We performed a population-based, retrospective cohort study with data from linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed renal cell carcinoma (RCC) diagnosed between 1995 and 2010. Cox proportional hazards (PH) models, propensity score models, and competing risks models were used to assess the impact of treatment choice. PN compared to RN reduces the risk of ESRD requiring renal replacement therapy in a modern cohort of patients (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). PN is associated with a lower risk of new-onset CKD, lower risk of cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.iii ACKNOWLEDGEMENTS

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Section: The Current Standard -Partial Nephrectomymentioning

confidence: 99%

“…Though not every tumour or patient is an ideal candidate for PN, experts have estimated that approximately 70% of patients presenting with T1a tumours have lesions for which it is technically feasible to perform PN and this procedure should thus be considered the standard of care for such patients. 43 …”

Section: Overall Ratesmentioning

confidence: 99%

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

European Urology Supplements

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“…Thus, partial nephrectomy is considered the gold standard for treating localized renal tumors 2,3 . Warm renal ischemia is commonly performed during partial nephrectomy to achieve a bloodless surgical field, however renal ischemia has been associated with renal function impairment 4 .…”

Section: ■ Introductionmentioning

confidence: 99%

The relationship between renal warm ischemia time and glomerular loss. An experimental study in a pig model

et al. 2017

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The relationship between renal warm ischemia time and glomerular loss. An experimental study in a pig model 1 Acta Cir. Bras. 2017;32(5):334-341 Abstract Purpose: To investigate the glomerular number after different warm ischemia times. Methods: Thirty two pigs were assigned into four groups. Three groups (G10, G20, and G30) were treated with 10, 20, and 30 minutes of left renal warm ischemia. The sham group underwent the same surgery without renal ischemia. The animals were euthanized after 3 weeks, and the kidneys were collected. Right kidneys were used as controls. The kidney weight, volume, cortical-medullar ratio, glomerular volumetric density, volume-weighted mean glomerular volume, and the total number of glomeruli per kidney were obtained. Serum creatinine levels were assessed pre and postoperatively. Results: Serum creatinine levels did not differ among the groups. All parameters were similar for the sham, G10, and G20 groups upon comparison of the right and left organs. The G30 group pigs' left kidneys had lower weight, volume, and cortical-medullar ratio and 24.6% less glomeruli compared to the right kidney. A negative correlation was found between warm ischemia time and glomerular number. Conclusions: About one quarter of glomeruli was lost after 30 minutes of renal warm ischemia. No glomeruli loss was detected before 20 minutes of warm ischemia. However, progressive glomerular loss was associated with increasing warm ischemia time.

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“…Bu bağlamda böbreğe lokalize RHK'nin güncel tedavisi; mükemmel sağkalım ve yüz güldürücü onkolojik sonucu nedeniyle NKC'dir (19). Avrupa ve Amerika Üroloji Dernekleri'nin kılavuzlarında T1 böbrek tümörü tedavisinde artık NKC altın standart yöntem olmuş ve komorbiditesi nedeniyle cerrahisi riskli olan hastalarda ablatif yöntemler ve izlem kendine yer bulmuştur (1,20).…”

Section: Discussionunclassified

The Effects of Radical Nephrectomy and Nephron Sparing Surgery on Glomerular Filtration Rate for the Patients who Underwent Surgery for Localized Renal Mass

Güdeloğlu¹,

Akdoğan²

2016

Acta Oncol Tur.

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ÖZETAmaç: Bu çalışmada, radikal nefrektomi (RN) ile nefron koruyucu cerrahinin (NKC) uzun dönem böbrek fonksiyonları üzerine etkisini ortaya koymak amaçlanmıştır. Hastalar veYöntem: Hacettepe Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı'nda Ocak 1990 -Nisan 2011 tarihleri arasında renal kitle nedeniyle ameliyat edilen 1016 hastaya ait veriler, retrospektif olarak incelenmiştir. Tanı anında metastatik olduğu bilinen 78 olgu çalışma dışı tutulmuştur. Bulgular: Çalışmaya alınan olguların 579'u (%61,7) erkek ve 359'u (%38,3) kadındır. 624 olguya RN, 314 olguya NKC yapılmıştır. Hastaların ortalama takip süresi RN yapılan grupta 46.7 ay iken, NKC uygulanan grupta 39.9 aydır. Ortalama radyolojik tümör boyutu sırasıyla 75±33,5 mm ve 37,8±26 mm'dir (p<0.001). Ortalama ameliyat süresi RN ve NKC grupları için sırasıyla 137.6 ve 139.5 dakikadır. NKC uygulanan grupta ortalama sıcak iskemi süresi 18,9±6,8 (3-36) dakikadır. Uzun dönem takip sonunda RN yapılan gruptaki kreatinin değerindeki ortalama 0,51 mg/dl artış, NKC uygulanan gruptaki 0,39 mg/dl artıştan anlamlı şekilde daha fazladır (p<0.001). Uzun dönem takipte preoperatif GFR'ı ≥60 olan hastaların halen GFR değerinin ≥60 olarak devam etme oranları, RN ve NKC yapılan gruplarda sırasıyla %47.6 ve %74.8 olarak tespit edilmiştir (p<0.001). Sonuç: Çalışmamızda GFR'de azalma oranının uzun dönemde RN yapılan hastalarda NKC yapılanlara göre daha fazla olduğu bulunmuştur. T1 renal tümörü olan birçok olguda RN ile bütün böbreği çıkarmak fazladan tedavidir. T1 renal tümörü olan hastalarda teknik olarak mümkün oldukça parsiyel nefrektomi tercih edilmelidir. Anahtar kelimeler: Renal Hücreli Karsinom, Radikal Nefrektomi, Nefron Koruyucu Cerrahi, Glomerüler Filtrasyon Oranı ABSTRACT Objectives: The goal of this study was to demonstrate the long-term effects of radical nephrectomy (RN) and nephron sparing surgery (NSS) on kidney functions. Patients and Methods: The medical records of 1016 patients who underwent kidney surgery from January 1990 to April 2011 at Hacettepe University School of Medicine, Department of Urology were retrospectively collected and analyzed. Metastatic 78 patients at presentation were excluded. Results: Radical nephrectomy and nephron sparing surgery was performed in 624 and 314 cases, respectively. Male to female ratio was 579/314. The mean follow up was 46.7 and 39.9 months for RN and NSS, respectively. The mean radiological tumor size was 75±33,5 mm for RN and 37,8±26 mm for NSS (p<0.001). The mean duration of surgery for RN and NSS was 137 and 139 minutes, respectively. The mean warm ischemia time for NSS was 18.9 minutes. Serum creatinin level was increased 0.51mg/dl and 0.39mg/dl for RN and NSS after long-term follow up, respectively (p<0.001). Glomerular filtration rate (GFR) was ≥ 60 ml/min/m 2 in 47.6% and 74.8% of RN and NSS patients in long-term follow up, respectively (p<0.001). Conclusion: Decrease in GFR was more prominent in RN compared to NSS patients in long term. Therefore, removing the whole kidney for especially T1 renal tumours is over ...

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Guideline for Management of the Clinical T1 Renal Mass

Cited by 1,610 publications

References 36 publications

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

The relationship between renal warm ischemia time and glomerular loss. An experimental study in a pig model

The Effects of Radical Nephrectomy and Nephron Sparing Surgery on Glomerular Filtration Rate for the Patients who Underwent Surgery for Localized Renal Mass

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