Nephron-sparing Surgery Is Equally Effective to Radical Nephrectomy for T1BN0M0 Renal Cell Carcinoma: A Population-based Assessment

Crépel, Maxime; Jeldres, Claudio; Perrotte, Paul; Capitanio, Umberto; Isbarn, Hendrik; Shariat, Shahrokh F.; Liberman, Daniel; Sun, Maxine; Lughezzani, Giovanni; Arjane, Philippe; Widmer, Hugues; Graefen, Markus; Montorsi, Francesco; Patard, Jean Jacques; Karakiewicz, Pierre I.

doi:10.1016/j.urology.2009.04.098

Cited by 91 publications

(53 citation statements)

References 21 publications

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“…This limitation was shared with previous studies. 10,30 Accounting for comorbidities could have altered the current findings. However, we adjusted for OCM, which might represent a relative estimate for comorbidities.…”

Section: 18mentioning

confidence: 92%

Partial and radical nephrectomy provide comparable long‐term cancer control for T1b renal cell carcinoma

et al. 2013

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Abbreviations & AcronymsObjectives: To examine utilization rates of partial nephrectomy relative to radical nephrectomy for T1b renal cell carcinoma in contemporary years, to identify sociodemographic and disease characteristics associated with partial nephrectomy use, and to compare effectiveness of partial versus radical nephrectomy with respect to cancer control. Methods: Using the Surveillance, Epidemiology, and End Results database, 16 333 patients treated with partial or radical nephrectomy for T1bN0M0 renal cell carcinoma between 1988 and 2008 were identified. Logistic regression models were carried out to identify determinants of partial nephrectomy. Subsequently, cumulative incidence rates of cancer-specific and other-cause mortality between partial and radical nephrectomy were assessed, within the matched cohort. Furthermore, competing-risks regression analyses were used for prediction of cancer-specific mortality, after adjusting for other-cause mortality, and vice versa. Results: The utilization rate of partial nephrectomy increased from 1.2% in 1988 to 15.9% in 2008 (P < 0.001). Younger individuals, smaller tumors, persons of black race, as well as men, were more likely to be treated with partial nephrectomy in the current cohort (all P ≤ 0.002). In the post-propensity cohort, the 5-and 10-year cancer-specific mortality rates were 4.4 and 6.1% for partial versus 6.0 and 10.4% for radical nephrectomy, respectively (P = 0.03). Competing-risks regression analyses showed that nephrectomy type was not statistically significantly associated with cancer-specific mortality, even after adjusting for other-cause mortality (hazard ratio 0.89, P = 0.5). Conclusions: Despite providing a comparable cancer control, the use of partial over radical nephrectomy for T1b renal cell carcinoma in USA has remained limited in recent years.

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Section: 18mentioning

confidence: 92%

Partial and radical nephrectomy provide comparable long‐term cancer control for T1b renal cell carcinoma

et al. 2013

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“…10,11 However, NSS has been underused due to its technical difficulty. In addition to tumour size, other anatomical features, such as location and growth pattern, which also represent surgical complexity, play critical roles when assessing the feasibility of NSS to treat renal tumours.…”

Section: Discussionmentioning

confidence: 99%

The association between the anatomical features of renal tumours and the functional outcomes of robot-assisted partial nephrectomy

Lee

Cho

Jeon

et al. 2014

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Cite as: Can Urol Assoc J 2014;8(11-12):e810-4. http://dx.doi.org/10.5489/cuaj.1642 Published online November 24, 2014. AbstractIntroduction: We evaluated the the association between PADUA scores and postoperative renal function (after robot-assisted partial nephrectomy [RAPN]) and between PADUA scores and warm ischemic time (during RAPN). Methods: We reviewed the clinical records of 106 patients who underwent RAPN for a single localized renal tumour between April 2009 and June 2012. Postoperative renal function was evaluated using estimated glomerular filtration rate (eGFR) in 85 patients who were followed for at least 6 months. PADUA scores for renal tumours were calculated using contrast-enhanced computed tomography images, if needed, along with magnetic resonance images in some cases. Results: A PADUA score ≥10 and WIT ≥30 minutes were observed in 18 (17.0%) and 51 (48.1%) cases, respectively. PADUA scores were significantly correlated with WIT (p = 0.019) and percent change in eGFR at 6 months postoperatively (p = 0.005). PADUA score (continuous variable, odds ratio [OR] 1.694, p = 0.007) and the high-risk group (PADUA score ≥10) (OR 5.429; p = 0.020) were significantly associated with a WIT of ≥30 minutes by multivariate analysis. A 1-point increase in the PADUA score was associated with an eGFR decrease of >20% at 6 months after RAPN (OR 1.799; p = 0.076). In addition, a PADUA score ≥10, or high risk, (OR 13.965; p = 0.003) was an independent predictor of an eGFR decrease of >20% at 6 months after RAPN. Conclusions: The PADUA classification can reliably predict WIT and postoperative renal functional outcome after RAPN. Furthermore, the study suggests that anatomical aspects of renal tumours are associated with functional outcome after RAPN.

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“…7,20 This work translates the continuous growth of this technique in an oncologic institution. We presented a 9.6% cases for positive surgical margin (PSM), which is slightly above what is described in literature, ranging from 0% -7%.…”

Section: Effects On Renal Functionmentioning

confidence: 97%

Parcial Nephrectomies - results of 12 years from an Oncology Institution

et al. 2016

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RESUMOIntrodução: O diagnóstico de carcinoma de células renais tem vindo a aumentar nos últimos anos, sobretudo pelo seu diagnóstico incidental, e de forma paralela tem aumentado as indicações para cirurgia preservadora de nefrónios. Objectivos: Rever uma série de nefrectomias parciais de uma instituição oncológica em termos técnicos, sobrevida, variação da função renal. Material e Métodos: Análise retrospectiva de todos os doentes com neoplasia renal, submetidos a nefrectomia parcial na nossa instituição entre janeiro de 2000 e dezembro de 2012. Resultados: Foram realizadas 156 nefrectomias parciais, 85 em homens e 71 em mulheres, com média de idades de 62 ± 15 anos. A abordagem foi em 23 casos transperitoneal laparoscópica sendo nos restantes 133 por lombotomia. O tempo médio de isquemia foi < 25 minutos em todos os doentes. A taxa de complicações foi de 10,9%, a maioria grau 2 e 3 da escala de Clavien-Dindo. Os tumores tinham dimensões médias de 2,9 ± 1,4 cm e a margem cirúrgica estava focalmente atingida por tumor em 9,6% dos casos. Em termos histológicos, verificou-se em 26,2% dos casos a existência de carcinoma de células renais de células claras, sendo os oncocitomas a neoplasia benigna mais frequente com 14,7% do total. No seguimento dos doentes verificaram-se 4 casos de recidiva e um óbito pela doença. A variação média na taxa de filtração glomerular estimada foi de -5,3 mL/min por 1,73 m 2 (p < 0,001). Não se verificou associação entre tempo de isquemia, índice de massa corporal, idade, score ASA, existência de complicações com este decréscimo da taxa de filtração glomerular. Discussão: Os casos de margens cirúrgicas positivas são ligeiramente superiores ao descrito na literatura, todavia não foram encontrados factores preditivos para tal e em última análise não foi encontrada recidiva tumoral ou qualquer influência na sobrevida destes doentes. Apesar de ter se ter verificado uma diminuição significativa da taxa de filtração glomerular, o tempo de isquemia quente foi muito reduzido e apenas cinco doentes apresentaram taxa de filtração glomerular de novo < 60 mL/min por 1,73 m 2 e apenas dois iniciaram programa regular de hemodiálise. Um centro de grande volume cirúrgico parece ser necessário para optimização técnica e resolução de complicações. Conclusão: A série de nefrectomias parciais apresenta resultados de controlo oncológico e de preservação da função renal sobreponíveis aos de outras séries da literatura. Esta é uma técnica segura que apresenta bons resultados, justificando o seu crescimento. Palavras-chave: Insuficiência Renal Crónica; Nefrectomia; Taxa de Filtração Glomerular. ABSTRACTIntroduction: The diagnosis of renal cell carcinoma has been increasing in recent years, especially due to incidental cases, and thus indication for nephron-preserving surgery has also risen. Objectives: To review a series of partial nephrectomies from an oncology institution namely technique features, survival and change in renal function. Material and Methods:A retrospective analysis of all patients with renal ...

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Nephron-sparing Surgery Is Equally Effective to Radical Nephrectomy for T1BN0M0 Renal Cell Carcinoma: A Population-based Assessment

Cited by 91 publications

References 21 publications

Partial and radical nephrectomy provide comparable long‐term cancer control for T1b renal cell carcinoma

Partial and radical nephrectomy provide comparable long‐term cancer control for T1b renal cell carcinoma

The association between the anatomical features of renal tumours and the functional outcomes of robot-assisted partial nephrectomy

Parcial Nephrectomies - results of 12 years from an Oncology Institution

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