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

Kolla, Surendra B.; Ercole, Cesar E.; Spiess, Philippe E.; Pow‐Sang, Julio M.; Sexton, Wade J.

doi:10.1111/j.1464-410x.2010.09293.x

Cited by 28 publications

(15 citation statements)

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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: 95%

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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Section: Resultsmentioning

confidence: 95%

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

El-Ghazaly

Mason

Rendon

2014

CUAJ

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“…[13] and Kolla et al . [14]. Finally, both of our patients had known RVTT on preoperative imaging, whereas all the patients reported by Woldu et al .…”

Section: Discussionmentioning

confidence: 49%

“…[13] and five of the seven patients reported by Kolla et al . [14] were T1a preoperatively. For these reasons, our patients should be expected to experience a greater decrease in eGFR after surgery.…”

Section: Discussionmentioning

confidence: 94%

“…[13] had only one (of eight) patient with solitary kidney and Kolla et al . [14] had five (of seven) patients with solitary kidney. Second, our patients had a larger mean tumour size compared with those reported by Woldu et al .…”

Section: Discussionmentioning

confidence: 99%

“…However, the evidence for oncological success of NSS in the case of RCC involving the renal vein is limited [11]. Some reports suggest that in highly selected patients with locally advanced RCC, NSS is feasible and provides acceptable oncological outcomes [12–14]. This study reviews oncological and functional outcomes of NSS for known‐stage T3a RCC (based on the American Joint Cancer Committee 2010 TNM staging criteria) with renal vein involvement in two patients with solitary kidney.…”

Section: Introductionmentioning

confidence: 99%

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Partial nephrectomy in two patients with known T3a tumours involving the renal vein

et al. 2011

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Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Although nephron‐sparing surgery (NSS) has became accepted therapy for T1 tumours, radical nephrectony is considered the best therapy for T3a tumours involving the renal vein. NSS can be considered in T3a or greater tumours if imperative indications exist, such as bilateral disease or solitary kidney. However, there is little published data on the characteristics of these patients, the impact of surgery on their renal function, and long‐term oncologic outcomes. This study profiles single‐institution experience with nephron‐sparing surgery for known T3a tumours involving the renal vein, including patient characteristics, tumour characteristics, preoperative and follow‐up imaging, preoperative and follow‐up estimated glomerular filtration rate, length of temporary postoperative haemodialysis, and oncologic outcome. Additionally, we compare this to other published data on nephron‐sparing surgery for similar tumors. OBJECTIVE To present two patients with T3a tumours involving the renal vein who underwent nephron‐sparing surgery (NSS) for imperative reasons. PATIENTS AND METHODS Retrospective chart review of patients who underwent NSS for renal cell carcinoma (RCC) with known renal vein tumour thrombus (RVTT). Both patients underwent open partial nephrectomy and renal vein thrombectomy of a solitary kidney. Primary outcomes of the study include radiographic evidence of recurrence, haemodialysis requirement and estimated glomerular filtration rate (eGFR) before and after surgery. RESULTS Patient 1 is 24 months from NSS and has no evidence of recurrence based on CT scan. His final pathology revealed a 9‐cm, T3a, clear cell, Fuhrman grade II carcinoma. He spent 42 days on haemodialysis and is now off all dialysis. His preoperative and most recent eGFR are 48 and 23 mL/min/1.73 m2 based on the Modification of Diet in Renal Disease (MDRD) equation and 69.4 and 29.8 mL/min by the Cockcroft–Gault equation. Patient 2 is 9 months from NSS and has no evidence of recurrence based on CT scan. Her final pathology revealed a 6‐cm, T3a, clear cell, Fuhrman grade II–III carcinoma. She spent 30 days on haemodialysis and is now off all dialysis. Her preoperative and most recent eGFR are 58 and 30 mL/min/1.73 m2 based on the MDRD equation and 62.2 and 32.8 mL/min by the Cockcroft–Gault equation. CONCLUSION Based on our review, preservation of renal function and favourable oncological outcome can be accomplished with NSS in patients with known stage T3a RCC with RVTT and should be considered in carefully selected patients.

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Eligibility and Radiologic Assessment for Adjuvant Clinical Trials in Kidney Cancer

Agrawal

Haas²,

Lane

et al. 2020

JAMA Oncol

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To harmonize the eligibility criteria and radiologic disease assessment definitions in clinical trials of adjuvant therapy for renal cell carcinoma (RCC).METHOD On November 28, 2017, US-based experts in RCC clinical trials, including medical oncologists, urologic oncologists, regulators, biostatisticians, radiologists, and patient advocates, convened at a public workshop to discuss eligibility for trial entry and radiologic criteria for assessing disease recurrence in adjuvant trials in RCC. Multiple virtual meetings were conducted to address the issues identified at the workshop. RESULTSThe key workshop conclusions for adjuvant RCC therapy clinical trials were as follows. First, patients with non-clear cell RCC could be routinely included, preferably in an independent cohort. Second, patients with T3-4, N+M0, and microscopic R1 RCC tumors may gain the greatest advantages from adjuvant therapy. Third, trials of agents not excreted by the kidney should not exclude patients with severe renal insufficiency. Fourth, therapy can begin 4 to 16 weeks after the surgical procedure. Fifth, patients undergoing radical or partial nephrectomy should be equally eligible. Sixth, patients with microscopically positive soft tissue or vascular margins without gross residual or radiologic disease may be included in trials. Seventh, all suspicious regional lymph nodes should be fully resected. Eighth, computed tomography should be performed within 4 weeks before trial enrollment; for patients with renal insufficiency who cannot undergo computed tomography with contrast, noncontrast chest computed tomography and magnetic resonance imaging of the abdomen and pelvis with gadolinium should be performed. Ninth, when feasible, biopsy should be undertaken to identify any malignant disease. Tenth, when biopsy is not feasible, a uniform approach should be used to evaluate indeterminate radiologic findings to identify what constitutes no evidence of disease at trial entry and what constitutes radiologic evidence of disease. Eleventh, a uniform approach for establishing the date of recurrence should be included in any trial design. Twelfth, patient perspectives on the use of placebo, conditions for unblinding, and research biopsies should be considered carefully during the conduct of an adjuvant trial. CONCLUSIONS AND RELEVANCEThe discussions suggested that a uniform approach to eligibility criteria and radiologic disease assessment will lead to more consistently interpretable trial results in the adjuvant RCC therapy setting.

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

Cited by 28 publications

References 15 publications

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

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

Partial nephrectomy in two patients with known T3a tumours involving the renal vein

Eligibility and Radiologic Assessment for Adjuvant Clinical Trials in Kidney Cancer

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