Nephron-sparing surgery of renal cell carcinoma with a normal opposite kidney: long-term outcome in 180 patients

Filipas, D.; Fichtner, Jan; Spix, Claudia; Black, Peter C.; Carus, Wolfgang; Hohenfellner, R.; Thüroff, Joachim W.

doi:10.1016/s0090-4295(00)00656-7

Cited by 74 publications

(32 citation statements)

References 29 publications

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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%

“…24,26,32 Having examined 839 elective PNs for malignant tumours, Patard and colleagues reported no significant differences in positive surgical margins, local or distant recurrence rates, and CSS between tumours less than or greater than 4 cm. 24 Similar findings were reported by Filipas and colleagues.…”

Section: Discussionmentioning

confidence: 99%

“…In their study, 132 patients with tumours less than 4 cm had a 5-year OS rate of 91.6% and a CSS rate of 98.1%, compared to an OS rate of 92.6% and a CSS rate of 97.0% in 48 patients with a tumour diameter greater than 4 cm. 32 Antonelli and colleagues compared the outcomes of 313 T1a and T1b managed by either RN or PN, with a mean follow-up period between 54.3 and 78.8 months. There were no significant differences between the masses assigned to either procedure in regards to histologic type and the incidence of high nuclear grade (G3-4).…”

Section: Discussionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

El-Ghazaly

Mason

Rendon

2014

CUAJ

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“…With advances in radiologic imaging, an increasing proportion of renal cancers are discovered incidentally with a high proportion of these tumors being small (40). As a result, nephron-sparing surgical techniques have become widely employed for renal cancer therapy, even in patients with a normally functioning contralateral kidney, and there is increasing interest in the urologic and radiologic communities in another form of conservative therapy for renal neoplasms-computed tomographyguided radiofrequency ablation of tumors in situ (8,9,11,40). The main objection to conservative surgery for renal cell carcinoma is concern over local recurrence due to the possible presence of small tumors with malignant potential in the portion of kidney left behind.…”

Section: Discussionmentioning

confidence: 99%

Molecular Genetic Evidence for the Independent Origin of Multifocal Papillary Tumors in Patients with Papillary Renal Cell Carcinomas

Jones¹,

Eble²,

Wang³

et al. 2005

Clinical Cancer Research

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Purpose: In patients with papillary renal cell carcinoma, it is not uncommon to find two or more anatomically distinct and histologically similar tumors at radical nephrectomy.Whether these multiple papillary lesions result from intrarenal metastasis or arise independently is unknown. Previous studies have shown that multifocal clear cell renal cell carcinomas express identical allelic loss and shift patterns in the different tumors within the same kidney, consistent with a clonal origin. However, similar clonality assays for multifocal papillary renal cell neoplasia have not been done. Molecular analysis of microsatellite and chromosome alterations and X-chromosome inactivation status in separate tumors in the same patient can be used to study the genetic relationships among the coexisting multiple tumors. Experimental Design: We examined specimens from 21 patients who underwent radical nephrectomy for renal cell carcinoma. All patients had multiple separate papillary lesions (ranging from 2 to 5). Eighteen patients had multiple papillary renal cell carcinomas. Seven had one or more papillary renal cell carcinomas with coexisting papillary adenomas. Genomic DNA samples were prepared from formalin-fixed, paraffin-embedded tissue sections using laser-capture microdissection. Loss of heterozygosity assays were done for six microsatellite polymorphic markers for putative tumor suppressor genes on chromosomes 3p14 (D3S1285), 7q31 (D7S522), 9p21 (D9S171), 16q23 (D16S507), 17q21 (D17S1795), and 17p13 (TP53). X-chromosome inactivation analyses were done on the papillary kidney tumors from three female patients. Fluorescence in situ hybridization analysis was done on the tumors of selected patients showing allelic loss at loci on chromosome 7 and/or chromosome 17. Results:Twenty of 21 (95%) cases showed allelic loss in one or more of the papillary lesions in at least one of the six polymorphic markers analyzed. A concordant allelic loss pattern between each coexisting kidney tumor was seen in only 1of 21 (5%) cases. A concordant pattern of nonrandom X-chromosome inactivation in the coexisting multiple papillary lesions was seen in two of three female patients. A discordant pattern of X-chromosome inactivation was seen in the tumors of the other female patient. Fluorescence in situ hybridization showed that the majority of tumors analyzed had gains of chromosomes 7 and 17. Two patients had one tumor with chromosomal gain and another separate tumor that did not. Conclusion: Our data suggest that, unlike multifocal clear cell renal cell carcinomas, the multiple tumors in patients with papillary renal cell carcinoma arise independently. Thus, intrarenal metastasis does not seem to play an important role in the spread of papillary renal cell carcinoma, a finding that has surgical, therapeutic, and prognostic implications.Approximately 10% to 15% of renal cell carcinomas are of the papillary type. Papillary renal cell carcinoma is more frequently multifocal than other types of renal cell carcinoma (1 -5).Papillary ad...

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“…Series that have looked at enucleation alone have also included both ex vivo 'bench' procedures and in vivo procedures together [10,25], or a procedure performed ex vivo in radical nephrectomy specimens [16,26]. Hence, there are few series that have analyzed only the results of in vivo enucleation for the treatment of small renal tumors in the presence of a normal contralateral kidney [13,14,27]. Furthermore, the impact of operative technique such as the method for achieving vascular control on the outcome of surgery has not been analyzed in great detail either.…”

Section: Introductionmentioning

confidence: 99%

Surgical Enucleation for the Treatment of Renal Tumors

2003

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Introduction: We analyzed our institutional experience with surgical enucleation for the primary treatment of small renal tumors. Materials and Methods: Patient demographics, histological features, effect of different types of vascular control and outcome from surgery were analyzed in 45 patients. A majority of the tumors (67%) were diagnosed incidentally. Results: All were stage T₁, 77% were low grade (I–II) and 23% were high grade (III–IV). Complication occurred in 12% of patients. At a mean follow-up of 34 months (range 7–97), 28 of 33 patients (84%) with malignant tumors were alive without evidence of disease. One patient with a solitary kidney developed recurrent tumor after enucleation that required nephrectomy. Mean operative time was significantly lower with the compression technique versus direct vascular control (164 ± 12 min vs. 233 ± 15 min, p = 0.002). There were no differences in outcome between the two techniques. Conclusions: Surgical enucleation is a safe and viable procedure for the treatment of small renal tumors. Manual compression of the kidney appears to be at least as effective as clamping of the renal vessels in obtaining vascular control during the procedure and is more expeditious.

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Nephron-sparing surgery of renal cell carcinoma with a normal opposite kidney: long-term outcome in 180 patients

Cited by 74 publications

References 29 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

Molecular Genetic Evidence for the Independent Origin of Multifocal Papillary Tumors in Patients with Papillary Renal Cell Carcinomas

Surgical Enucleation for the Treatment of Renal Tumors

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