Nephron-Sparing Surgery for Renal Tumors Measuring More Than 7 cm: Morbidity, and Functional and Oncological Outcomes

Bigot, Pierre; Hétet, Jean-François; Bernhard, Jean-Christophe; Fardoun, T.; Audenet, François; Xylinas, Évanguelos; Ploussard, Guillaume; Pignot, G.; Bessède, Thomas; Ouzaïd, I.; Robine, Edouard; Brureau, Laurent; Treigny, O. Merigot De; Maurin, C.; Long, Jean-Alexandre; Rouffilange, J.; Hoarau, N.; Lebdai, Souhil; Rouprêt, Morgan; Bastien, Laurence; Neuzillet, Y.; Mongiat-Artus, Pierre; Verhoest, G.; Zerbib, Marc; Ravery, Vincent; Rigaud, J.; Bellec, L.; Baumert, H.; Chautard, Denis; Bensalah, Karim; Escudier, Bernard; Paparel, P.; Grenier, N.; Rioux‐Leclercq, Nathalie; Azzouzi, Abdel-Rahmène; Soulié, M.; Patard, Jean‐Jacques

doi:10.1016/j.clgc.2013.09.004

Cited by 28 publications

(14 citation statements)

References 30 publications

(52 reference statements)

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“…For SRM, similar complication rates of PN and RN could be shown 5 . With increasing tumor complexity, increasing rates of high‐grade complications, for PN of approximately 20%, have been described 9,10,12,25 . Serious complications of PN are urinomas and arteriovenous fistulas 7,8,12,13 .…”

Section: Discussionmentioning

confidence: 90%

Partial nephrectomy preserves renal function without increasing the risk of complications compared with radical nephrectomy for renal cell carcinomas of stages pT2–3a

et al. 2020

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Objectives: To compare the operative and functional result of partial and radical nephrectomy in renal cell carcinomas of stages pT2-3a. Methods: Consecutive patients with renal cell carcinoma of stages pT2-3a, cN0 and cM0, who underwent partial or radical nephrectomy between January 2005 and October 2019 at a tertiary care center were included. Data were collected retrospectively. Endpoints included severe postoperative complications (Clavien-Dindo classification ≥3), acute and chronic renal function impairment, and overall survival. Uni-and multivariable outcome analyses were based on logistic regression. Results: A total of 158 patients were included (110 radical nephrectomy and 48 partial nephrectomy). Over time, partial nephrectomy was increasingly used. A RENAL score ≥10 was the only independent predictor influencing the surgical approach (radical nephrectomy vs partial nephrectomy, odds ratio 8.62, 95% confidence interval 3.32-22.37, P < 0.001). No significant differences in complications for radical nephrectomy versus partial nephrectomy were found (12.7% vs 8.3%, P = 0.424). Renal function was better preserved in the partial nephrectomy group (the latest chronic kidney disease stage ≥3: radical nephrectomy 73% vs partial nephrectomy 41%, P = 0.005). The surgical approach was a significant factor for chronic kidney disease (odds ratio 51.07, 95% confidence interval 3.57-730.59, P = 0.004). Overall survival did not significantly differ between radical nephrectomy and partial nephrectomy (mean overall survival 85.86 months, 95% confidence interval 3.83-78.36 vs 81.28 months, 95% confidence interval 4.59-72.29, P = 0.702). Conclusions: In selected patients, partial nephrectomy can be used in large or locally advanced renal cell carcinoma. Compared with radical nephrectomy, it allows better preservation of renal function without harboring an increased risk of severe postoperative complications.

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Section: Discussionmentioning

confidence: 90%

Partial nephrectomy preserves renal function without increasing the risk of complications compared with radical nephrectomy for renal cell carcinomas of stages pT2–3a

et al. 2020

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“…Preservation of renal function is a driving force for PN. When compared with RN for T2 renal masses or larger, PN demonstrates long‐term renal function preservation while maintaining a high cancer‐specific survival rate . New‐onset kidney disease was more prevalent after RN in comparison with PN (40.2% vs 16.3%) .…”

Section: Discussionmentioning

confidence: 99%

Robot‐assisted partial nephrectomy for large renal masses: a multi‐institutional series

et al. 2018

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For T2a tumours RAPN is a feasible treatment option in a select patient population when performed by experienced surgeons in institutions equipped to manage postoperative complications. Although RAPN was associated with greater blood loss and longer operating and ischaemia time in T2a tumours, it was not associated with greater complication or positive surgical margin rates compared with T1 tumours. Renal function preservation rates were equivalent for up to 24 months postoperatively; however, 12-month recurrence-free survival was significantly lower in the T2a group. Extended follow-up is required to further evaluate long-term survival.

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“…When renal cortical tumors are small and low stage, the opportunity for surgical cure remains high even for clear cell RCC with aggressive features. Although Fuhrman grade III–IV and microvascular invasion clearly remain very strong predictors of kidney cancer–specific mortality [23– 27], they may not have the same level of significance when a nomogram is applied to a population with tumors that are smaller and lower stage and have yet to metastasize. The result of these factors is reflected in the significantly higher actual 5-yr RFP of this cohort when compared with the original cohort (96.7% vs 80.9%).…”

Section: Discussionmentioning

confidence: 99%

Validation of a Postoperative Nomogram Predicting Recurrence in Patients with Conventional Clear Cell Renal Cell Carcinoma

Lee

Feifer

Feuerstein

et al. 2018

European Urology Focus

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Nephron-Sparing Surgery for Renal Tumors Measuring More Than 7 cm: Morbidity, and Functional and Oncological Outcomes

Cited by 28 publications

References 30 publications

Partial nephrectomy preserves renal function without increasing the risk of complications compared with radical nephrectomy for renal cell carcinomas of stages pT2–3a

Partial nephrectomy preserves renal function without increasing the risk of complications compared with radical nephrectomy for renal cell carcinomas of stages pT2–3a

Robot‐assisted partial nephrectomy for large renal masses: a multi‐institutional series

Validation of a Postoperative Nomogram Predicting Recurrence in Patients with Conventional Clear Cell Renal Cell Carcinoma

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