Nephron Sparing Surgery for Renal Tumors: Indications, Techniques and Outcomes

Uzzo, Robert G.; Novick, Andrew C.

doi:10.1016/s0022-5347(05)66066-1

Cited by 813 publications

(385 citation statements)

References 132 publications

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“…15 The local tumour recurrence was 3.5%. Similar results were reported in a meta-analysis 16 looking at a series of patients undergoing open partial nephrectomy (OPN) from 1980 to 2000. A study that compared 100 cases of laparoscopic partial nephrectomy (LPN) with OPN concluded that OPN remains the standard of care for SRM.…”

Section: Fundingsupporting

confidence: 80%

Surveillance versus ablation for incidentally diagnosed small renal tumours: the SURAB feasibility RCT

Soomro

Lecouturier

Stocken

et al. 2017

Health Technol Assess

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Background There is uncertainty around the appropriate management of small renal tumours. Treatments include partial nephrectomy, ablation and active surveillance. Objectives To explore the feasibility of a randomised trial of ablation versus active surveillance. Design Two-stage feasibility study: stage 1 – clinician survey and co-design work; and stage 2 – randomised feasibility study with qualitative and economic components. Methods Stage 1 – survey of radiologists and urologists, and development of patient information materials. Stage 2 – patients identified across eight UK centres with small renal tumours (< 4 cm) were randomised (1 : 1 ratio) to ablation or active surveillance in an unblinded manner. Randomisation was carried out by a central computer system. The primary objective was to determine willingness to participate and to randomise a target of 60 patients. The qualitative and economic data were collected separately. Results The trial was conducted across eight centres, with a site-specific period of recruitment ranging from 3 to 11 months. Of the 154 patients screened, 36 were eligible and were provided with study details. Seven agreed to be randomised and one patient was found ineligible following biopsy results. Six patients (17% of those eligible) were randomised: three patients received ablation and no serious adverse events were recorded. The 3- and 6-month data were collected for four (67%) and three (50%) out of the six patients, respectively. The qualitative substudy identified factors directly impacting on the recruitment of this trial. These included patient and clinician preferences, organisational factors (variation in clinical pathway) and standard treatment not included. The health economic questionnaire was designed and piloted; however, the sample size of recruited patients was insufficient to draw a conclusion on the feasibility of the health economics. Conclusions The trial did not meet the criteria for progression and the recruitment rate was lower than hypothesised, demonstrating that a full trial is presently not possible. The qualitative study identified factors that led to variation in recruitment across the sites. Implementation of organisational and operational measures can increase recruitment in any future trial. There was insufficient information to conduct a full economic analysis. Trial registration Current Controlled Trials ISRCTN31161700. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 81. See the NIHR Journals Library website for further project information.

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Section: Fundingsupporting

confidence: 80%

Surveillance versus ablation for incidentally diagnosed small renal tumours: the SURAB feasibility RCT

Soomro

Lecouturier

Stocken

et al. 2017

Health Technol Assess

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“…All are similarly effective, but carry their own morbidity, with a complication rate up to 30% in several series [6]. Some patients have contraindications to general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous US-guided RF thermal ablation for malignant renal tumors: preliminary results in 13 patients

et al. 2004

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Minimally invasive treatment for small renal cell carcinoma (RCC) can be necessary in selected patients and, anyway, is desirable. In situ ablation techniques, including RFA, have been developed. The aim of this study is to evaluate the feasibility, safety and short-term local effectiveness of percutaneous US-guided RFA in a small series, as well as mid-term patient outcome. Thirteen patients with a total of 18 tumors (17 small lesions, 35 mm in size or less, and a larger one, 75 mm in size) underwent 19 RFA sessions. Seven patients had a solitary kidney, and three suffered from VHL disease, too. We treated four lesions in a patient with a bilateral tumor. In another patient, three lesions were ablated. Seventeen tumors were RCC; one was a metastasis from lung cancer. Eight lesions were parenchymal, six exophytic, two parenchymal/exophytic, one parenchymal/central and one central. A monopolar RF system with multitined expandable electrode needles was used. The 35-mm lesion underwent two sessions; the 75-mm lesion was treated with transcatheter arterial embolization before RFA. Tumors with complete loss of contrast enhancement at short-term CT (or MR) were considered successfully treated. Percutaneous US-guided RFA was always feasible without major complications. The success rate after a single treatment in tumors less than 35 mm in size was 88.2% (15/17) and rose to 94.1% (16/17) after the second treatment of the largest lesion. After a mean 14-month follow-up, no successfully treated lesions recurred locally. Only the patient with metastasis from lung cancer died from disease progression in a further location, while all other patients are alive, with renal function still sufficient to avoid dialysis. US guidance allows an easy and safe percutaneous approach for RFA of small non-parahilar RCC. The treatment is locally effective and can be proposed as a minimally invasive therapy for patients with contraindications to surgery or to those expressing an informed consent. Based on the results of this study and of the literature, mid-term results on the clinical usefulness are very encouraging.

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“…Nephron-sparing surgery (NSS) is the mainstay of treatment for small renal cell carcinoma due to the well-preserved renal function and comparable oncological outcome to radical nephrectomy (RN) [1,2,3,4]. However, NSS can be technically challenging and morbidity can be high, especially in patients with large, centrally located or endophytic tumors.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the RENAL Nephrometry Scoring System in Adopting Nephron-Sparing Surgery for cT1 Renal Cancer

et al. 2012

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Objective: The RENAL nephrometry scoring system characterizes tumors according to their size, growth pattern, location and nearness to the renal sinus or collecting system. The current study aims to evaluate the RENAL nephrometry scoring system in adopting nephron-sparing surgery (NSS) for cT1 renal cancer. Methods: Clinicopathological data of 200 consecutive patients who had undergone radical nephrectomy (RN) or NSS for clinical stage T1 renal cell cancer at our single institution during 2005-2009 were investigated retrospectively. Results: Of 200 patients, 103 were scheduled for RN, whereas 97 were planned to undergo NSS, 9 of whom actually underwent RN. Those who were planned to undergo NSS were younger and had smaller tumors (p < 0.001). The median RENAL score was significantly lower among those who were originally assigned to NSS (5, range 4-10) versus RN (8, range 4-11) (p < 0.001). Three months after surgery, the renal function of patients who had been scheduled for NSS was significantly better than in those treated by RN (p < 0.001). Conclusions: This study suggests that the RENAL nephrometry scoring system is a useful tool in adopting NSS for cT1 renal cancer and that objective decision-making for NSS was possible.

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Nephron Sparing Surgery for Renal Tumors: Indications, Techniques and Outcomes

Cited by 813 publications

References 132 publications

Surveillance versus ablation for incidentally diagnosed small renal tumours: the SURAB feasibility RCT

Surveillance versus ablation for incidentally diagnosed small renal tumours: the SURAB feasibility RCT

Percutaneous US-guided RF thermal ablation for malignant renal tumors: preliminary results in 13 patients

Evaluation of the RENAL Nephrometry Scoring System in Adopting Nephron-Sparing Surgery for cT1 Renal Cancer

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