Nephron Sparing Surgery for Central Renal Tumors: Experience With 33 Cases

Black, Peter C.; Filipas, D.; Fichtner, Jan; Hohenfellner, R.; Thüroff, Joachim W.

doi:10.1016/s0022-5347(05)67794-4

Cited by 65 publications

(32 citation statements)

References 32 publications

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“…We believe that under most circumstances, it is reasonable to consider techniques for renal surface hypothermia during complex cases of NSS. Breach of the collecting system is more likely with centrally located tumours, as has been reported previously [14,15]. All of the present patients had collecting system entry and one developed a urine leak afterward that required intervention in the form of JJ stent.…”

Section: Discussionsupporting

confidence: 78%

Nephron‐sparing surgery for pathological stage T3b renal cell carcinoma confined to the renal vein

et al. 2010

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RESULTSAll seven patients had centrally located endophytic tumours. There were absolute indications for NSS in six patients (solitary kidney in five, renal insufficiency in one). The clinical stage was T1a in five and T3b in two patients; in those with cT1a, thrombus was first identified with intraoperative ultrasonography in two and by palpation of the renal vein or during the NSS in the remaining three. Renal surface hypothermia was applied in four cases (mean 77 min) and warm ischaemia in three (mean 38 min). The mean (range) tumour size was 3.9 (2.5-6) cm and all the tumours were clear cell RCC on histology, and all had negative surgical margins. The mean estimated glomerular filtration rate (eGFR) decreased by 24% after surgery. One patient developed new-onset renal failure (eGFR < 30 mL/min/1.73 m 2 ). Postoperative urine leak occurred in one patient successfully managed with a JJ stent.One patient developed a local recurrence with level III inferior vena caval (IVC) tumour thrombus 9 months after NSS and was managed with radical excision and IVC thrombectomy followed by postoperative dialysis. Six other patients were free of recurrence with no need for dialysis at a mean follow-up of 30 months.

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Section: Discussionsupporting

confidence: 78%

Nephron‐sparing surgery for pathological stage T3b renal cell carcinoma confined to the renal vein

et al. 2010

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“…Information on surgical approach was available for 1564 patients from 15 studies and included 1311 open PN, 252 laparoscopic PN, and 1 robotic PN. 15,[17][18][19][20]22,25,27,28,30,[32][33][34][35][36] The mean tumour diameter was 5 and 8.1 cm for masses 4 to 7 cm and >7 cm in diameter, respectively. The median follow-up duration was available for 1735 patients (71%) and was estimated at 4.5 years.…”

Section: Resultsmentioning

confidence: 94%

Oncological outcomes of partial nephrectomy for tumours larger than 4 cm: A systematic review

El-Ghazaly

Mason

Rendon

2014

CUAJ

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Introduction: Many medical associations recommend nephronsparing surgery (NSS) for tumours larger than 4 cm amenable to partial nephrectomy (PN). These recommendations are, however, mostly based on isolated reports. We systematically review the oncological outcomes of partial nephrectomy procedures performed for tumours larger than 4-cm. Methods: A PubMed search was carried out using keywords "partial nephrectomy" and "nephron sparing" for records dating back to 1995. In total, 2136 abstracts were analyzed; from these, 174 studies were scrutinized. We identified 32 manuscripts reporting size-specific cancer-specific survival rates for masses greater than 4 cm. From each of these studies, we recorded the number of PN, tumour diameter, follow-up duration, 5-and 10-year recurrence, overall and cancer-specific survival rates (OS, CSS). We also calculated weighted OS and CSS rates. Results: This systematic review includes 2445 patients with renal tumours larger than 4 cm who underwent PN: 1858 patients with tumours between 4 to 7 cm, 410 patients with tumours larger than 7 cm and 177 patients with tumours greater than 4 cm (exact size unknown). Our analysis revealed weighted 5-year CSS rates of 95.4%, 86.2% and 93.9% for tumours 4 to 7 cm, >7 cm, and all tumours >4 cm, respectively. The respective 5-year OS rates were 84.7%, 76.4%, and 84.7%. Conclusions: We found excellent 5-year CSS and OS rates for patients with tumours 4 to 7 cm treated with PN. These outcomes compare favourably to those reported in historical radical nephrectomy (RN) series for similarly sized tumours. Thus, PN is an acceptable and often preferred treatment for renal masses >4 cm which are amenable to nephron-sparing procedures.

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“…There are several definitions of central tumors, of which the best accepted are those of Black et al (11), which consider that the lesion is completely surrounded by normal renal tissue, and that of Brown et al (12) that define those with a distance shorter than 5 mm from the collection system or hilar vessels.…”

Section: Discussionmentioning

confidence: 99%

Anatrophic nephrotomy as nephron-sparing approach for complete removal of intraparenchymal renal tumors

et al. 2012

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InTRODUcTIOnWith the development of imaging diagnosis techniques, and the higher number of requested exams, there has been a growth of the incidence of small renal tumors, and an increase of the indication of nephron-sparing surgery, with excellent oncological and functional outcomes (1). In the last years, the incidental lesions are responsible for more than 60% of kidney tumors and 80% of these are in stages I and II (2).Nephron-sparing renal surgery has been increasingly used for small renal mass (<4 cm) and, in selected cases, up to 7 cm renal tumors with similar oncological outcomes compared to radical nephrectomy, (3-5) with small complication ratio (6). The 5-year recurrence-free survival is approximately 96% for lesions smaller than 4 cm, and of 83% for lesions from 4 to 7 cm (7).However, renal occult tumors diagnosed by imaging techniques represent greater technical diffi culties for localization and resection, and may Objective: Partial nephrectomy for small kidney tumors has increased in the last decades, and the approach to non-palpable endophytic tumors became a challenge, with larger chances of positive margins or complications. The aim of this study is to describe an alternative nephron-sparing approach for small endophytic kidney tumors through anatrophic nephrotomy. Patients and Methods: A retrospective analysis of patients undergoing partial nephrectomy at our institution was performed and the subjects with endophytic tumors treated with anatrophic nephrotomy were identifi ed. Patient demographics, perioperative outcomes and oncological results were evaluated. Results: Among the partial nephrectomies performed for intraparenchymal tumors between 06/2006 and 06/2010, ten patients were submitted to anatrophic nephrotomy. The mean patient age was 42 yrs, and the mean tumor size was 2.3 cm. Mean warm ischemia time was 22.4 min and the histopathological analysis showed 80% of clear cell carcinomas. At a mean follow-up of 36 months, no signifi cant creatinine changes or local or systemic recurrences were observed. Conclusion: The operative technique described is a safe and effective nephronsparing option for complete removal of endophytic renal tumors. Anatrophic Nephrotomy as ABSTRAcTARTIcLe InfO _______________________________________________________________ _____________________

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Nephron Sparing Surgery for Central Renal Tumors: Experience With 33 Cases

Cited by 65 publications

References 32 publications

Nephron‐sparing surgery for pathological stage T3b renal cell carcinoma confined to the renal vein

Nephron‐sparing surgery for pathological stage T3b renal cell carcinoma confined to the renal vein

Oncological outcomes of partial nephrectomy for tumours larger than 4 cm: A systematic review

Anatrophic nephrotomy as nephron-sparing approach for complete removal of intraparenchymal renal tumors

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