Nephron sparing surgery in tumours greater than 7 cm

Aubert, Nicolas; Audenet, François; McCaig, Fiona; Delavaud, Christophe; Verkarre, Virginie; Guilchet, T. Le; Dariane, C.; Pettenati, C.; Slaoui, H; Méjean, Arnaud; Timsit, Marc Olivier

doi:10.1016/j.purol.2018.03.009

Cited by 8 publications

(6 citation statements)

References 18 publications

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“…A signi cant result of 8% versus 20% median eGFR reduction in PN group and RN group was noted. [11] These ndings aligned with those reported by Breau et al, where no signi cant difference was observed in oncological outcome but a signi cantly lower elevation of serum creatinine level (9.5% versus 33%) was found in patients treated with PN versus RN for cT2 renal tumors. [12] To investigate the impacts on the development of renal failure after PN and RN, McKiernan et al found that RN was associated with a higher risk of chronic renal insu ciency compared to PN.…”

Section: Discussionsupporting

confidence: 90%

Perioperative, Oncological, and Functional Outcomes of Retroperitoneal Laparoscopic or Robotic-Assisted Partial Nephrectomy for > 7 cm Renal Tumors

Lin,

Hsieh,

Tseng

et al. 2024

Preprint

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Background: Partial nephrectomy (PN) has been the main strategy for treating cT1 (≤ 7cm) renal tumors. Previous studies have established PN's safety and effectiveness over radical nephrectomy (RN) for cT1 tumors. However, the efficacy and safety of retroperitoneal PN for larger renal tumors (> 7cm) remained controversial. Through a size-based comparative analysis of cT1 and cT2 tumors undergoing retroperitoneal PN, we explored the impact of renal tumors larger than 7cm on perioperative, oncological, and functional outcomes. Materials and Methods: From January 2017 to April 2021, we collected data from 201 patients undergoing retroperitoneal laparoscopic or robot-assisted PN. Of these, 173 (86.1%) had tumors ≤ 7 cm (Group A) and 28 (13.9%) had tumors > 7 cm (Group B). We analyzed demographics (gender, age, Body Mass Index, Charlson Comorbidity Index, preoperative hemoglobin and renal function, tumor location, operative method, RENAL score, and complexity), perioperative (operative time, warm ischemic time, estimated blood loss, hospital stay, surgical margins, complications), and functional outcomes (changes in renal function pre- and postoperatively), along with recurrence rates. Results: Mean tumor sizes in Group A and Group B were 3.67 ± 1.56 cm and 9.90 ± 2.97 cm, respectively. RENAL score analysis revealed a significant difference (7.64 vs. 9.21, P < 0.0001), attributed to the Radius and Exophytic/Endophytic property parameters. Furthermore, Group B exhibited significantly higher tumor complexity(P = 0.0009). In perioperative outcomes, Group B had a prolonged warm ischemic time (18.90 vs 22.60 min, P = 0.0486). However, there was no significant difference in estimated blood loss and complication rates. Regarding functional outcomes, only the reduction of estimated glomerular filtration rate on postoperative day 1 was significant (-0.74 vs -8.31, p = 0.016), with no significant differences at 3 months, 6 months, or 1 year postoperatively. Conclusion: Retroperitoneal PN for cT2 tumors achieves similar oncological outcomes and long-term renal function preservation for cT1 tumors. Additionally, despite managing larger sizes and higher complexity in cT2 tumors, retroperitoneal PN provided a non-inferior complication rate. Given its effectiveness, safety, and functional preservation, retroperitoneal PN has the potential to be the preferred option for renal tumors larger than 7cm.

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Section: Discussionsupporting

confidence: 90%

Perioperative, Oncological, and Functional Outcomes of Retroperitoneal Laparoscopic or Robotic-Assisted Partial Nephrectomy for > 7 cm Renal Tumors

Lin,

Hsieh,

Tseng

et al. 2024

Preprint

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“…Fifteen retrospective studies including 5,056 patients who underwent nephrectomy (PN, 1975; RN, 3081) were included by careful selection (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Among the included studies, the majority of cases were from the USA, and the remainder were varied.…”

Section: Resultsmentioning

confidence: 99%

“…Preoperative eGFR (17,21,24,29) in the original literature, postoperative eGFR (17,20,21,25), and decline in eGFR (20)(21)(22)25) within a limited follow-up period to evaluate the effect of PN vs. RN on renal function. Cumulative analysis of the included studies showed that the preoperative eGFR was higher and the baseline renal function was better in patients who underwent PN (MD: 1.57 ml/min/1.73 Âm 2 ; 95% CI: 0.70, 2.44; p = 0.0004).…”

Section: Resultsmentioning

confidence: 99%

Partial Nephrectomy Versus Radical Nephrectomy for Clinical T2 or Higher Stage Renal Tumors: A Systematic Review and Meta-Analysis

et al. 2021

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ObjectiveThe choice of surgical method for clinically diagnosed T2 or higher stage kidney cancer remains controversial. Here, we systematically reviewed and collected published comparative studies on renal function, oncologic outcomes, and perioperative results of partial nephrectomy (PN) versus radical nephrectomy (RN) for larger renal tumors (T2 and above), and performed a meta-analysis.Evidence AcquisitionFollowing searches of PubMed, Web of Science, and Embase, the original studies on PN vs. RN in the treatment of T2 renal cancer were screened through strict inclusion and exclusion criteria. RevMan 5.4 was used for data analysis of the perioperative results, renal function, and oncologic outcomes of the two surgical methods for T2 renal tumor therapy. The weighted mean difference was used as the combined effect size for continuous variables, while the odds ratio (OR) or risk ratio (RR) was used as the combined effect size for binary variables. Both variables used a 95% confidence interval (CI) to estimate statistical accuracy. In cases with low heterogeneity, the fixed-effects model was used to pool the estimated value; otherwise, the random-effects model was used when significant heterogeneity was detected.ResultsFifteen retrospective studies including 5,056 patients who underwent nephrectomy (PN: 1975, RN: 3081) were included. The decline in estimated GFR (eGFR) after PN was lower than RN [(MD: −11.74 ml/min/1.73 m2; 95% CI: −13.15, −10.32; p < 0.00001)]. The postoperative complication rate of PN was higher than that of PN (OR: 2.09; 95% CI: 1.56, 2.80; p < 0.00001)], and the postoperative overall survival (OS) of PN was higher than that of RN (HR: 0.77; 95% CI: 0.65, 0.90; p = 0.002), and tumor recurrence (RR, 0.69; 95% CI: 0.53, 0.90; p = 0.007). No obvious publication bias was found in the funnel chart of the OS rates of the two groups of patients.ConclusionsPN is beneficial for patients with T2 renal tumors in terms of OS and renal function protection. However, it is also associated with a higher risk of surgical complications.

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“…The postoperative complications will increase as the size of the tumor increases, but the main concerns regarding performing partial nephrectomy in larger tumors are the oncological outcome. The recent reports mentioned that although the complication rate is higher in larger tumors, recurrence and survival are not significantly different between partial and radical nephrectomy groups [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Partial nephrectomy of a huge solid-cystic renal mass with final pathology of renal cell carcinoma

Mohammadi

Aghamir

2022

Journal of Surgical Case Reports

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Partial nephrectomy has been established as a standard treatment of renal mass <4 cm(cT1a), but mostly it is performed in larger tumors of size up to 7 cm (cT2b). The maximum size of a tumor that could undergo partial nephrectomy is controversial. In this case report, we present a case of a large renal mass (17 cm) that underwent open partial nephrectomy successfully. To our knowledge, this case is the giant tumor that underwent partial nephrectomy in the literature. Partial nephrectomy could be performed if technically feasible irrespective of the tumor size.

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Nephron sparing surgery in tumours greater than 7 cm

Cited by 8 publications

References 18 publications

Perioperative, Oncological, and Functional Outcomes of Retroperitoneal Laparoscopic or Robotic-Assisted Partial Nephrectomy for > 7 cm Renal Tumors

Perioperative, Oncological, and Functional Outcomes of Retroperitoneal Laparoscopic or Robotic-Assisted Partial Nephrectomy for > 7 cm Renal Tumors

Partial Nephrectomy Versus Radical Nephrectomy for Clinical T2 or Higher Stage Renal Tumors: A Systematic Review and Meta-Analysis

Partial nephrectomy of a huge solid-cystic renal mass with final pathology of renal cell carcinoma

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Nephron sparing surgery in tumours greater than 7 cm

Cited by 8 publications

References 18 publications

Perioperative, Oncological, and Functional Outcomes of Retroperitoneal Laparoscopic or Robotic-Assisted Partial Nephrectomy for &gt; 7 cm Renal Tumors

Perioperative, Oncological, and Functional Outcomes of Retroperitoneal Laparoscopic or Robotic-Assisted Partial Nephrectomy for &gt; 7 cm Renal Tumors

Partial Nephrectomy Versus Radical Nephrectomy for Clinical T2 or Higher Stage Renal Tumors: A Systematic Review and Meta-Analysis

Partial nephrectomy of a huge solid-cystic renal mass with final pathology of renal cell carcinoma

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Perioperative, Oncological, and Functional Outcomes of Retroperitoneal Laparoscopic or Robotic-Assisted Partial Nephrectomy for > 7 cm Renal Tumors

Perioperative, Oncological, and Functional Outcomes of Retroperitoneal Laparoscopic or Robotic-Assisted Partial Nephrectomy for > 7 cm Renal Tumors