Morbidity and Clinical Outcome of Nephron-Sparing Surgery in Relation to Tumour Size and Indication

Patard, Jean‐Jacques; Pantuck, Allan J.; Crépel, Maxime; Lam, John S.; Bellec, L.; Albouy, Baptiste; Lopes, David; Bernhard, Jean-Christophe; Guilhot, François; Lacroix, B.; Taille, Alexandre de la; Salomon, Laurent; Pfister, Christian; Soulié, M.; Tostain, Jacques; Ferrière, Jean-Marie; Abbou, Claude C.; Colombel, Marc; Belldegrun, Arie S.

doi:10.1016/j.eururo.2007.01.039

Cited by 206 publications

(137 citation statements)

References 26 publications

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“…11 Conversely, a comparable incidence of PSMs between patients with tumors 4 cm and > 4 cm has been found in other retrospective open and laparoscopic series. 31,32 In a recent report from the Ontario Cancer Registry that evaluated 788 open and laparoscopic PNs, Ani et al found significant correlations between increasing tumor size and margin status, with a 4-fold higher risk of PSM in pT1b tumors (P ¼ .002). 9 In our study the mean tumor dimension and the clinical and pathological stage failed to correlate with PSM status.…”

Section: Riccardo Schiavina Et Almentioning

confidence: 99%

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

Schiavina

Serni

Mari

et al. 2015

Clinical Genitourinary Cancer

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The early oncological goal of any partial nephrectomy (PN) is to achieve negative surgical margins (SMs). Several factors have been advocated as predictors of positive SMs (PSMs) after nephron-sparing surgery (NSS). In our study, age, upper pole tumor location, standard PN and Fuhrman 3/4 nuclear grade were found to be independent predictors of PSMs at multivariable analysis. Further evaluations are required to verify the oncological effect of the PSM on local and systemic recurrence. Background: The purpose of this study was to evaluate the predictors of positive margins in one of the largest available prospective multi-institutional studies. Patients and Methods: We evaluated all patients who underwent NSS for radiologically diagnosed kidney tumors between January 2009 and December 2012 at 19 urological Italian centers (Registry of Conservative Renal Surgery [RECORd] project). Preoperative and anthropometric data, comorbidities, intraoperative and postoperative outcomes, and histological findings were analyzed. The negative and PSMs were compared according to the clinical and surgical variables. Multivariable logistic regression models were applied to analyze predictors of PSMs. Results: Eight hundred consecutive patients were evaluated. Seven hundred sixty-one (95.1%) and 39 patients (4.9%) achieved negative and PSMs, respectively. Patients with PSMs were significantly older compared with those with negative margins (median age: 66.6 vs. 61.8 years, respectively; P ¼ .001). A higher incidence of PSMs was observed when NSS was performed for renal masses located in the upper pole (P ¼ .001). A lower rate of PSMs was found in patients treated with simple enucleation rather than standard PN (1.6% vs. 7.4%, respectively; P < .0001). A greater incidence of PSMs was found in Fuhrman 3/4 tumors (11.3%; P < .0001). At multivariable analysis, age (odds ratio [OR], 1.04; P ¼ .01), upper pole tumor location (OR, 2.85; P ¼ .005), standard PN (OR, 3.45; P ¼ .004), and Fuhrman 3-4 nuclear grade (OR, 4.81; P ¼ .001) were found to be independent predictors of PSMs. Conclusion: In our multi-institutional report, young age, simple enucleation, middle or lower tumor location, and low-grade tumor were demonstrated to be independent predictors of negative SMs.

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Section: Riccardo Schiavina Et Almentioning

confidence: 99%

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

Schiavina

Serni

Mari

et al. 2015

Clinical Genitourinary Cancer

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“…Asumiendo dicha dispersión de datos, la tasa de complicaciones global tiene un rango de 8-33% (Tabla 1), lo que la hace comparable a las tasas de complicaciones en la nefrectomía parcial abierta (5,5-38%) 38,[46][47] .…”

Section: Npl En Riñón úNicounclassified

Papel de la laparoscopia ante la masa renal menor de 4 cm

Briones

Zarranz

Escrig

2009

Actas Urológicas Españolas

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N adie cuestiona en 2008 que la vía de elección para la exéresis de una glándula suprarrenal es la laparoscopia 1 . Tampoco se discute el cambio en la cirugía renal que ha supuesto la nefrectomía radical laparoscópica 2 . Por otro lado, todos estamos viviendo el incremento exponencial del diagnóstico de masas renales pequeñas (MRP) 3 , entendiendo éstas como aquellas menores de 4cm influenciados por el TNM y por la necesidad de un consenso en su definición. Original Papel de la laparoscopia ante la masa renal menor de 4 cmJosé Rubio Briones*, Javier Estébanez Zarranz**, J.L. Domínguez Escrig*** ResumenEl incremento en el diagnóstico incidental de masas renales pequeñas (MRP) -menores de 4cm-ha obligado a considerar tratamientos mínimamente invasivos para las mismas, sobre todo por el alto porcentaje de patologías no malignas indistinguibles de las tumorales radiológicamente. El acceso laparoscópico ha cobrado por tanto una importancia capital en el manejo de dichas masas, en un intento de disminuir la morbilidad de la lumbotomía.La nefrectomía parcial laparoscópica (NPL) es una técnica en evolución en la mayoría de centros que por un lado compite con la nefrectomía parcial abierta como técnica de elección y por otro lado competirá en un futuro con las técnicas no exeréticas. Estas también se han podido desarrollar de una manera más precisa gracias a la laparoscopia.En este artículo pretendemos, basándonos en una revisión estandarizada de la prolífica literatura a cerca del tratamiento de la MRP, revisar las innovaciones tecnológicas y las mejoras técnicas que la vía de abordaje laparoscópica nos va deparando, no solo como técnica exerética, sino como vehículo de tratamientos mínimamente invasivos, remarcando también los requerimientos de los Servicios de Urología y las mejoras que podrían hacerse en los sistemas sanitarios para que la NPL ganara terreno en el tratamiento de la MRP.La progresiva depuración de la técnica y la mejora del arsenal laparoscópico y de agentes hemostasiantes van a incrementar la indicación de NPL en un futuro. La escasa frecuencia de la patología y la necesidad de optimizar la técnica, obligarían a los responsables sanitarios a centralizar esta patología en centros con experiencia en laparoscopia y en nefrectomía parcial abierta. Role of laparoscopy in the presence of a renal mass under 4 cm in size AbstractThe increasingly common incidental diagnosis of small renal masses (SRMs)(measuring under 4 cm in size) has led to the consideration of applying minimally invasive techniques to deal with them -particularly in view of the high percentage of non-malignant conditions of this size that are radiologically indistinguishable from tumor lesions. Accordingly, laparoscopic access has gained great importance in the management of these masses, in an attempt to lessen the morbidity associated with lumbotomy.Laparoscopic partial nephrectomy (LPN) is an evolving technique in most centers; on one hand it competes with open partial nephrectomy as the technique of choice, and on the other it will c...

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“…(Leibovich et al, 2004) In a similar vein, Patard et al noted that 3 year disease-specific survival rates were comparable at 98% and 97% (p=0.8) when partial nephrectomy patients were stratified by tumor size less than and greater than 4cm, respectively. (Patard et al, 2007) Last, recent work has expounded upon these findings as it pertains to the laparoscopic management of T1bN0M0 tumors, documenting comparable cancer-specific mortality (3% vs 3%) and recurrence rates RN 3% vs PN 6%, p-0.40) for both procedures over a median follow-up of 57 months. (Simmons, Weight, and Gill, 2009) These studies thus set the precedent that nephron-sparing surgery is a viable option form an oncologic standpoint in an appropriately selected subset of patients with a medium-sized tumors when treated at centers experienced with these techniques.…”

Section: Partial Nephrectomy Is Increasingly Being Utilized In Mediummentioning

confidence: 99%

Renal Cortical Neoplasms and Associated Renal Functional Outcomes

Badalato¹,

Kates²,

Sadeghi³

et al. 2012

Diseases of Renal Parenchyma

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Morbidity and Clinical Outcome of Nephron-Sparing Surgery in Relation to Tumour Size and Indication

Abstract: Excellent cancer control and outcomes can be achieved with NSS in carefully selected patients with tumours >4 cm. Expanding the size indication of elective NSS results in an increased but acceptable morbidity.

Cited by 206 publications

References 26 publications

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

Papel de la laparoscopia ante la masa renal menor de 4 cm

Renal Cortical Neoplasms and Associated Renal Functional Outcomes

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